At Agewell we customize each
prescription formulation
specifically to each
patients' individual
requirements. We
strive to provide the utmost
in customer care on every
order. Please call us
with any questions
pertaining to your
compounding request, we are
here to discuss any
questions or concerns you
may have pertaining to your
prescription.

Compounded
Medications:

Enrofloxacain 11.35
mg/ml Oral Suspension

Itraconzazole 20mg/ml
Oral Suspension

Erythromycin
ethylsuccinate 46.8% and
rifampin 5% Oral
Suspension

Estradiol 5mg/ml and
progesterone 100mg/ml
oil injection solution

Progesterone 100mg/ml
oil injection solution

Aluminum Hydroxide oral
suspension

Calcitriol 4 nanograms/0.25
L

Calcitriol 16 nanograms
/ml oral oil solution

Diethylstilbestrol Oral
Capsules

Protamine Zinc insulin
40 and 100 u/ml
injection suspension

Dexamethasone phosphate
0.1% ophthalmic ointment

Idoxuridine 0.1%
ophthalmic Solution

Tacrolimus 0.03%
ophthalmic ointment

Tacrolimus 0.03%
ophthalmic Solution

Metronidazole Benzoate
125mg/ml Oral Suspension

Acetyl-D-Glucosamine (N)
100mg/ml injection
solution

Hyaluronic Acid 10mg/ml
injection

TRANSDERMAL
MEDICATION:

Have you ever
thought about
applying a
transdermal
preparation to the
inside of an
animal's ear or
another hairless
area as an alternate
route of systemic
administration? It's
quick and easy, and
many medications are
compatible with
transdermal bases.
Transdermal delivery
is particularly
useful for animals
who should not be
stressed due to
cardiovascular or
hypertensive
illness. Also, it is
appreciated by
owners who no longer
have to deal with an
animal who resists
being medicated, and
the resulting
scratches! We can
also prepare topical
medications for
application at the
site of inflammation
or infection.

Advantages
of Transdermal
Dosage Forms

Various alternative
dosage forms permit
medication to be
absorbed via
non-oral routes to
meet an animal’s
specific needs.
Although the
parenteral and
rectal routes are
traditional
alternatives to oral
administration,
transdermal
absorption offers
many advantages.

For example:

When medication
is absorbed
directly into
the bloodstream
without first
entering the
gastrointestinal
system, a
smaller amount
of active
ingredient may
be required for
therapeutic
effect.

Direct
application and
absorption at
the target site
can mean higher
tissue levels
and lower blood
levels of
various
medications.
Side effects
such as GI
irritation can
be eliminated.

Various types of
drug
interactions may
be avoided when
one or more
interacting
medications are
administered
transdermally.

A substantial number
of references exist
in human medical
literature with
regard to the
efficacy of
transdermal
administration of
non-steroidal
anti-inflammatory
drugs and other
types of analgesics,
antiemetics, and
other medications.
We can compound
transdermal and
topical medications
using a suitable
base, and add
penetrant enhancers
if desired.

ANTI-INFECTIVE
THERAPY
:

Antibiotic/Antifungal/Antiviral
Therapy

Metronidazole
Metronidazole is
effective against a
variety of obligate
anaerobic bacteria
as well as anaerobic
protozoa such as
Giardia and
Trichomonas.
“Various salts of
metronidazole with
improved
palatability are now
available for
veterinary
patients... Cats and
birds accept the
benzoate salt much
more willingly than
they accept
metronidazole HCl
and do not seem to
be stressed by its
administration.”

Metronidazole should
be used with caution
in patients with
hepatic dysfunction.
Therapy should be
promptly
discontinued if
abnormal
neurological signs
appear, including
nystagmus, ataxia,
seizures, and
rigidity. All
benzene moieties
must be conjugated
with glucuronide to
facilitate
elimination and this
pathway is
inefficient in cats.
Therefore, doses of
metronidazole
benzoate above 200
mg/kg/day may
produce signs of
cumulative toxicity
in cats within 48 to
72 hours.

Compendium
Dec. 2000: 22(12);
pp. 1104, 1105,
1107, 1130

Esophageal
Strictures Secondary
to Administration of
Doxycycline Tablets
“The most common
causes of esophageal
strictures in dogs
and cats are
gastroesophageal
reflux during
anesthesia,
persistent vomiting,
or ingestion of
foreign bodies or
caustic agents. In
humans, esophageal
retention of oral
medication is a
common cause of
severe esophagitis.
Of the medications
proven to lead to
esophageal
ulceration,
doxycycline is most
often implicated. It
has been suggested
that pill-induced
esophagitis also
could occur in small
animals...”
Drug-induced
esophageal
ulceration usually
occurs when tablets
are taken with
little or no water
and adhere to the
esophageal mucosa.
Once this occurs,
flushing with large
quantities of liquid
fails to wash the
medication into the
stomach. Melendez et
al. of Colorado
State University
College of
Veterinary Medicine
report on three
cases of presumptive
doxycycline-induced
esophagitis in cats,
with resultant
stricture formation.
All cats had been
administered
fractions of
doxycycline tablets
one to three weeks
before presenting
with a chief
complaint of
regurgitation. “Two
of the cases
developed
regurgitation within
7 days after
initiation of
therapy with
doxycycline. One
cat, which was
treated while at an
animal shelter, was
noted to be
regurgitating the
day that it was
adopted,
approximately 2
weeks after being
treated with
doxycycline. No
other cause of
esophageal stricture
formation could be
identified.” If a
pet that has
received a
doxycycline tablet
shows sign of
esophagitis
(dysphagia,
excessive
salivation,
inappetence, and
regurgitation), the
doxycycline tablets
should be
discontinued.
Suggested therapy
for esophagitis
includes sucralfate
slurries, a
prokinetic agent
(i.e. cisapride) to
increase lower
esophageal sphincter
tone, and
anti-inflammatory
doses of
glucocorticoids to
prevent stricture
formation.

Feline Practice
28:2; 10-12 (Mar/Apr
2000)

Doxycycline can be
compounded as a
stable flavored
liquid preparation
or other palatable
dosage form to meet
the specific needs
of each animal and
owner.

Oral
Itraconazole for
Therapy of
Dermatophytosis
Caused by
Microsporum canis
Itraconazole could
be an effective
alternative to
griseofulvin that
has toxic effects
(particularly in
puppies based on
this author’s
experience) and
frequent therapeutic
relapses.
Itraconazole has
also been used to
successfully treat
M. canis infection
of cats and guinea
pigs.

Since
chloramphenicol
palmitate is no
longer commercially
available, we
contacted our
compounding
pharmacist for an
alternative for use
in our avian and
other small
patients, such as
rabbits and rodents.
The pharmacist
prepared a cola
flavored suspension
containing 30 mg/ml
of chloramphenicol
palmitate, which
could be
administered using a
small oral syringe.
However, birds did
not like the taste
and it was
reformulated into a
tutti fruitti and
pina colada syrup.
The “animal
appropriate” flavor
has really helped
with compliance,
because now the
birds and small
animals like to take
their medicine!

Note: To avoid
potential
antagonism,
chloramphenicol
should not be
administered
simultaneously with
penicillin or
streptomycin.
Chloramphenicol-containing
preparations should
not be administered
in conjunction with,
or two hours prior
to, the induction of
general anesthesia
with pentobarbital.

When administered
orally in dogs,
chloramphenicol is
well-tolerated, has
high clinical
efficacy, and a low
incidence of side
effects. The
recommended canine
dosage is 25 mg/lb
of body weight every
six hours.

Precautions:
Chloramphenicol
should be
administered
cautiously to
animals with
hematopoietic
dysfunction, or
impaired kidney or
liver function.

Antibiotic
Treats for Feline
Abscess
Submitted by:
Michael Briggs,
Pharm.D.
Veterinarian: Rich
Marchetti, D.V.M.
Patient: One year
old non-castrated
short-haired male
cat with abscess
from wound received
in fight. The owner
reported that the
cat, who is usually
affectionate and
friendly toward the
owner and house dog,
had been withdrawn,
on guard, and
growling for
approximately three
days. A thorn-like
projection near the
tail was found by
the owner, who
immediately took the
cat to the
veterinarian. The
cat was anesthetized
and the veterinarian
cleaned, debrided,
and shaved the area
of the wound, and
prescribed
amoxicillin 100 mg
daily for ten days.
The owner was
instructed to keep
the cat inside for
the duration of
therapy, to minimize
the risk of
superinfection and
avoid additional
injury.
Medication Problem:
The cat refused to
take liquids, and
was also resistant
to taking tablets
(“pilling”). The
required dose of
antibiotic was too
high for transdermal
treatment (due to
the amount of gel
that would need to
be applied for each
dose).

Solution: The
veterinarian called
our compounding
pharmacy and asked
if we could come up
with a palatable
dosage form. We
formulated a
fish-flavored
chewable treat
containing
amoxicillin 100 mg
to be given once
daily for ten days.
This dosage form
offers the advantage
of ease of
administration,
decreases the
potential for dosing
errors, and greatly
increases patient
compliance. The cat
readily consumed the
amoxicillin “treat”.
The wound did not
heal in a ten day
period, so five
additional days of
therapy were
required.

Comment: Our
pharmacy has
compounded this
preparation more
than ten times with
a 100% success rate.

Intranasal
Clotrimazole for
Treatment of Nasal
Aspergillosis in
Dogs
“Treatment of nasal
aspergillosis with
systemic antifungal
medications, such as
thiabendazole,
ketoconazole, and
fluconazole, has
been disappointing
because the response
rate is only 43 to
60%. Response to
oral administration
of itraconazole has
been approximately
60 to 70%... Topical
administration of
the imidazoles,
enilconazole, and
clotrimazole is more
effective than
orally administered
antifungal
medications.”

Topical
administration of
clotrimazole
resulted in
resolution of
clinical disease in
65% of dogs after 1
treatment and 87% of
dogs after one or
more treatments.
Topical
administration of
clotrimazole, using
either technique,
was an effective
treatment for nasal
aspergillosis in
dogs. Use of
non-invasive
intranasal infusion
of clotrimazole
eliminated the need
for surgical
trephination of
frontal sinuses in
many dogs and was
associated with
fewer complications.
Nasal discharge
ceased in most dogs
2 weeks after
topical treatment,
and the authors now
recommend
re-treatment with
clotrimazole if
nasal discharge has
not improved 2 weeks
after treatment.

“[Damage] of the
cribriform plate may
contraindicate use
of topical
treatment;
complications
arising from leakage
of antifungal
medications into the
CNS in dogs with
fungal rhinitis have
not been evaluated.”

J Am Vet Med
Assoc 1998 Aug
15;213(4):501-6

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Anim Hosp
Assoc 1998
Nov-Dec;34(6):487-92

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Azithromycin
is a form of
erythromycin with
improved action
against
gram-negative
organisms,
resistance to acid
degradation,
improved tissue
penetration, and a
prolonged
elimination
half-life.
Azithromycin shows
potential for use in
veterinary medicine,
particularly in cats
and certain avian
and exotic species.
“Lacking the
prokinetic action of
erythromycin,
azithromycin appears
to cause fewer GI
side effects and is
generally well
tolerated after oral
administration. Cats
appear to tolerate
the drug
particularly well...
Animals with a
history of
arrhythmias should
be monitored while
receiving the drug.
Some reduction in
dose may be
warranted in
patients with
hepatic or biliary
dysfunction,
although no
reduction appears
necessary in
patients with renal
dysfunction.” Please
consult our
compounding
pharmacist regarding
dosing.

Compendium of
Continuing Education
23:3 (March 2001),
pp. 242-7

Azithromycin
for R. equi
Infections in Foals
On the basis of
pharmacokinetic
values, minimum
inhibitory
concentrations of R.
equi isolates, and
drug concentrations
in pulmonary
epithelial lining
fluid (PELF) and
bronchoalveolar
cells, a single
daily oral dose of
10 mg/kg may be
appropriate for
treatment of R. equi
infections in foals.
Persistence of high
azithromycin
concentrations in
PELF and
bronchoalveolar
cells 48 hours after
discontinuation of
administration
suggests that after
5 daily doses, oral
administration at
48-hour intervals
may be adequate.

Am J Vet Res
2001
Dec;62(12):1870-5

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Itraconazole/DMSO
for Fungal Keratitis
in Horses
Fungal keratitis is
a serious
complication of
trauma to the eye.
Approximately
one-half of the
cases of fungal
infections have
involved the use of
eye ointments
containing
corticosteroids
after trauma to the
globe of the eye.
“Itraconazole is a
third generation
triazole that has
superior penetration
properties and a
wide spectrum of
activity. A 1%
solution of
itraconazole in a
30% DMSO and
petroleum base has
been shown to reach
high concentrations
within the stroma of
the cornea when
administered every 4
to 6 hours. In
general, every 6
hours is suitable
for all but Fusarium
sp which requires
every 4 hour
administration.”

Disease which is
rapidly ulcerating
“should also receive
treatment that helps
block the enzymes
(collagenase)
responsible for
ulceration. A 5%
acetylcysteine
solution and
autologous serum in
which 4 mg/ml of
EDTA has been added
has been
recommended. These
need to be instilled
hourly for best
effect. The
antimicrobial can be
added to the serum.”

Idoxuridine
Ophthalmic Drops for
Cats
The ocular signs of
feline herpesvirus I
(FHV-1) infection
include bilateral
conjunctivitis,
serous ocular
discharge which may
become mucoid or
mucopurulent, and
blepharospasm. If
corneal involvement
is present, topical
antivirals are
prescribed. Research
indicates that
idoxuridine is
effective against
FHV-1. Prolonged
contact with the
infected tissue is
required. The 0.1%
solution must be
applied five times
daily. Previously
marketed as Stoxil®,
the ophthalmic
solution is not
commercially
available at this
time.

Feline
Ocular Toxoplasmosis
“The anterior
uveitis seen in cats
with a positive
serum titer to
Toxoplasma gondii
may result from
immune-mediated
mechanisms and not
the presence or
replication of the
organism itself. As
a result, it is
unclear whether
systemic
antitoxoplasmic
therapy is
beneficial in these
cases.” Michael G.
Davidson, DVM, of
North Carolina State
University, College
of Veterinary
Medicine reports in
Vet Clin N Amer, Sep
2000, that he
“usually treats cats
with ocular lesions
and concurrent
systemic findings of
toxoplasmosis with
systemic clindamycin
(12.5 mg/kg PO twice
daily for 14-21
days) and
anti-inflammatory
therapy. Other
sources recommend
clindamycin 10-12.5
mg/kg every 12 hours
for 4 weeks. Oral
trimethoprim-sulfonamide
combination therapy
(15 mg/kg every 12
hours for 2 to 4
weeks) can also be
used to treat
toxoplasmosis but is
less suitable
because of potential
side effects caused
by folic acid
deficiency in cats.2
In T gondii
seropositive cats
exhibiting anterior
uveitis alone and
with no systemic
signs, Dr. Davidson
recommends topical
steroids and
atropine alone. If
the cat fails to
respond to topical
therapy alone within
1-3 weeks, systemic
clindamycin should
be added to the
treatment regimen.
The rationale for
the use of
corticosteroids is
to suppress the
damaging
inflammation in the
retina, which may
affect vision.
Corticosteroids are
typically
administered 1-2
days after
antibiotic therapy
has been initiated
to allow adequate
tissue levels of the
antimicrobial agent
to be achieved. [Dr.
Davidson] does not
recommend systemic
steroids in cats
with suspected
ocular toxoplasmosis
because of the risk
of exacerbating
systemic replication
of T gondii.”1
Swift and aggressive
treatment of uveitis
is necessary to
avoid such secondary
complications as
glaucoma, cataract
formation, and
retinal degeneration
or detachment.3

An 11 year-old male
cat showed
aggressive behavior
towards other cats
and also started
urinary spraying.
Buspirone 2.5mg/ml
flavored suspension
was tried. It
was extremely
difficult for the
owner to give the
oral suspension and
after a few days the
cat was vomiting the
medication.

OutcomeAfter the
first dose, the
owner noticed the
medication made the
cat too sleepy and
the dose was
decreased to 0.05ml
(1.25mg of
buspirone).
The cat’s aggressive
behavior has been
controlled on the
lower dose with a
few exceptions and
the owner then
increased the dose
to 2.5mg of
buspirone for a
couple of doses.
The owner is amazed
how easy it is to
apply the
medication.

Amitriptyline for
Behavioral and
Urinary Disorders
Amitriptyline
hydrochloride is one
of the most widely
used tricyclic
antidepressants
(TCAs) in companion
animal behavioral
medicine, exerting
antihistaminic,
anti-inflammatory,
analgesic, and
antidepressant
effects.
Amitriptyline
increases synaptic
activity of
serotonin and
norepinephrine, has
significant central
and peripheral
anticholinergic
activity, and
stimulates
beta-adrenergic
receptors in smooth
muscle (e.g. the
bladder), causing a
decrease in smooth
muscle excitability
and a subsequent
increase in bladder
capacity and
storage.

Although
amitriptyline has
been used
successfully to
treat
behavior-related and
urinary tract
disorders in cats
and dogs, the drug
is not approved by
the FDA for
veterinary use and
therefore is not
available as a
veterinary
preparation.

Compendium
23(5) May 2001:
433-7

ImipramineIn animals,
tricyclic
antidepressants have
actions similar to
those of
phenothiazines in
altering avoidance
behaviors.
Imipramine has been
used for the
following
indications:

Naltrexone
for Self-Mutilating
Behavior“Naltrexone
may be useful in the
treatment of
self-mutilating or
tail-chasing
behaviors in dogs or
cats... [A synthetic
opiate antagonist,]
naltrexone is
generally considered
to be
contraindicated in
patients physically
dependent on opiate
drugs, in hepatic
failure or with
acute hepatitis.”

Doses for
Dogs:

As adjunctive
therapy in behavior
disorders:

For tail chasing or
excessive licking:
First give 0.01mg/kg
SubQ of naloxone to
determine if
narcotic antagonists
may be effective. If
so, give naltrexone
PO at 1 - 2 mg/kg
daily. Long-term
therapy may be
required.
(Crowill-Davis 1992)

For the
adjunctive treatment
of acral pruritic
dermatitis:

2.2mg/kg PO once
daily for one month
trial. Some dogs
exhibit drowsiness
and minor changes in
behavior. 50-60% of
patients have
benefited...
(Rosychuck 1991)

Canine Acral
Lick Dermatitisinvolves
excessive licking of
the paws or flank,
even to the point of
self-mutilation, and
can produce
ulcerations and
infections that
require medical
treatment. Based on
patterns of behavior
and response to
medication,
veterinary
scientists propose
that canine acral
lick dermatitis,
also known as canine
compulsive disorder
(CCD), is an animal
model of human
obsessive-compulsive
disorder. A
randomized,
placebo-controlled,
double-blind
crossover clinical
study evaluated the
efficacy of the
medication
clomipramine for
treatment of CCD.
Fifty one dogs with
CCD were given
clomipramine 3 mg/kg
[1.3 mg/lb] of body
weight orally every
12 hours for 4 weeks
and then placebo for
4 weeks. While drug
therapy can be
helpful, therapy may
need to include
behavior
modification to
optimally manage
CCD.

J Am Vet Med
Assoc 1998 Dec
15;213(12):1760-6

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Arch Gen
Psychiatry 1992
Jul;49(7):517-21

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Fluoxetine
for Refractory
Owner-Directed
Dominance AggressionEvidence
suggests that social
dominance aggression
may be modulated by
serotonergic
mechanisms.
Fluoxetine
(Prozac®), a
specific inhibitor
of serotonin
reuptake, is a
popular human
antidepressant which
has been used
successfully to
decrease social
aggression in dogs
and monkeys.

J Am Vet Med
Assoc
1996;209:1585-1587

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Fluoxetine
for Urine Spraying
in Cats
Administration of
fluoxetine
hydrochloride for
treatment of urine
spraying in cats can
be expected to
considerably reduce
the rate of urine
marking. Pryor et
al. recommend that
most cats should be
treated more than
eight weeks before
treatment is
withdrawn. Cats that
vertically marked a
mean of > or = 3
times per week were
treated for 8 weeks
with fluoxetine
(1mg/kg PO daily-
dosage
individualized for
each cat by a
compounding
pharmacy) or
fish-flavored liquid
placebo. When
treatment was
discontinued after 8
weeks, the spraying
rate of cats that
had received
treatment varied.
The main adverse
reaction to the drug
was a reduction in
food intake, which
was observed in 4 of
9 treated cats.

J Am Vet Med
Assoc 2001 Dec
1;219(11):1557-61

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Inappropriate
Elimination in Cats:
Fluorescein to Find
the Culprit

In a multi-cat
household, it is
important to
determine which cat
is inappropriately
eliminating so that
the proper
intervention can be
made. Even if one
cat is observed
marking or urinating
outside the box, it
does not rule out
the possibility that
other cats are also
behaving
inappropriately.
When it is necessary
to identify which
cat in a multi-cat
household is
spraying or
inappropriately
eliminating,
fluorescein can be
orally administered
once daily in the
evening with food
for three days. That
cat's urine will
fluoresce under
ultraviolet light
for approximately 24
hours. To detect
urine containing the
fluorescein
indicator, the
client needs to scan
the household with a
commercial black
light or black light
purchased from a
novelty store.
Although urine will
commonly glow,
fluorescein treated
urine fluoresces a
characteristic
bright yellow.
Caution clients that
they may reveal
previously
undiscovered sites
of elimination;
advise them not to
become alarmed or
angry. By
administering the
dye to different
cats at two day
intervals, the
culprit can be
identified.

Pharmacological
support for urine
spraying or marking
is usually needed
only for cases with
underlying anxiety
or problems with
social interactions
between cats
(clomipramine), or
for cats with
interstitial
cystitis
(amitriptyline,
doxepin).
Administration of
fluoxetine
hydrochloride for
treatment of urine
spraying in cats may
also considerably
reduce the rate of
urine marking.

Cyproheptadine to
Control Urine
Spraying and as an
Antipruritic in CatsA
10-year-old
castrated male
domestic cat was
admitted to the
hospital at the
School of Veterinary
Medicine, Tufts
University. A
diagnosis of
territorial urine
marking was made.
Treatment included
behavior
modification and the
administration of
cyproheptadine,
which resulted in
the immediate arrest
of undesirable urine
marking.
Cyproheptadine
administration was
adjusted to
determine the lowest
dosage that
effectively
maintained the cat's
consistent use of
the litter box. It
was recommended to
continue
cyproheptadine
administration for
at least 1 year
before any attempt
to withdraw its use.
Another study
recommended a dose
of 2 mg, p.o., every
12 hours. This
antihistamine, also
prescribed for its
appetite stimulant
effects in cats, has
antiandrogenic
effects in other
species.

J Am Vet Med
Assoc 1999 Aug
15;215(4):501-2, 482

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Vet Med
Assoc 1999 Feb
1;214(3):369-71,
351-2

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Cyproheptadine
hydrochloride was
administered to 20
presumed or proven
allergic cats to
determine its
efficacy in
controlling
pruritus. Each cat
received 2 mg,
orally, every 12
hours. The pruritus
was satisfactorily
controlled in 9
cats. Side effects
were seen in 8 cats,
and included
polyphagia,
sedation,
vocalization,
affectionate
behavior, and
vomiting.

Can Vet J
1998
Oct;39(10):634-7

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Clomipramine
for Feline Anxiety

A study of 11 cats
assessed the
clinical response to
a treatment regimen
that included
clomipramine and
behavior
modification in cats
diagnosed with
anxiety-related or
obsessive-compulsive
disorders.
Presenting signs
were urine spraying
in seven cases,
overgrooming in
three and excessive
vocalization in one.
Clomipramine was
administered orally
once daily, with a
mean starting dose
of 0.4 mg/kg. If
necessary, the dose
was adjusted
according to the
clinical response of
each cat. The
average maintenance
dosage was 0.3 mg/kg
once daily. The
researchers
concluded that
clomipramine was
effective in
controlling the
signs of
anxiety-related and
obsessive-compulsive
disorders in 10 of
10 assessable cases
when used in
combination with
behavior
modification, and
the drug was well
tolerated.

Aust Vet J
1998
May;76(5):317-21

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Selegilineis a
monoamine oxidase
(MAO) inhibitor
indicated for use in
dogs to control
signs associated
with canine
cognitive
dysfunction syndrome
and uncomplicated
pituitary-dependent
hyperadrenocorticism
(PDH). Studies
suggest that
selegiline may
enhance survival
rates. The
recommended dose for
cognitive
dysfunction is 0.5
to 1 mg/kg, and for
PDH is 1 mg/kg,
orally each morning.
If no improvement is
seen after 2 months,
the dose can be
increased to the
maximum of
2mg/kg/day. If there
is no clinical
improvement after 1
month at 2mg/kg/day,
alternative therapy
or further
evaluation should be
considered.
“Overall, selegiline
is well tolerated...
Gastrointestinal
disturbances,
particularly
vomiting and
diarrhea, are the
most common side
effects reported.
Diarrhea may resolve
when the drug is
discontinued or the
dose decreased.
Other adverse
effects include
hyperactivity,
agitation,
restlessness, and
insomnia. A dose
reduction or
discontinuation of
therapy also
resolves these
problems.”

Compendium
March 2000;
22(3):204-5

CARDIOLOGY /
HYPERTENSION
:

Enalapril
for Cardiomyopathy
and CHF

“Enalapril maleate
is an
angiotensin-converting
enzyme (ACE)
inhibitor labeled to
treat mild to severe
heart failure in
dogs.” Research has
shown that enalapril
in combination with
diuretics - with or
without digitalis
glycosides -
“produces
statistically
significant clinical
improvement in dogs
with advanced heart
failure due to
mitral regurgitation
or dilated
cardiomyopathy” and
has demonstrated
“beneficial
hemodynamic and
clinical effects of
adding enalapril to
conventional therapy
for dogs with CHF...
Dogs treated with
enalapril and
conventional CHF
therapy survived two
times as long as did
those receiving
standard therapy
alone.”

Enalapril has also
“been effective in
treating
cardiomyopathy and
CHF in cats and
ferrets, and its
effects on blood
pressure in horses
and camels have been
studied.” Because
enalapril is a
prodrug and can not
be converted to its
active form
enalaprilat in
patients with severe
liver dysfunction,
captopril or
lisinopril might be
a better choice in
those patients.
Renal function
should be checked
before starting
enalapril therapy
and at least every
two months
thereafter. The most
common side effects
are
gastrointestinal,
but there have been
reports of
enalapril-induced
cough in dogs and a
bird. Hypotension is
a major concern if
overdose occurs.
NSAIDs, including
aspirin, may reduce
enalapril’s effect.
The injectable form
(enalaprilat) should
not be given orally
because it is very
poorly absorbed.

“The recommended
dose for enalapril
in dogs is 0.5 mg/kg
orally every 12 to
24 hours. The dose
for cats is 0.25 to
0.5 mg/kg orally
every 12 to 24
hours.”

Compendium,
Dec. 1999

Amlodipine
to Treat Feline
Systemic
Hypertension

Amlodipine, a
calcium channel
blocker, has an
antihypertensive
effect in cats with
coexistent systemic
hypertension and
renal insufficiency.
Its use may improve
the prognosis for
cats with systemic
hypertension by
decreasing the risk
of ocular injury or
neurologic
complications
induced by high
blood pressure (BP).
In a retrospective
study, medical
records from 69 cats
with systemic
hypertension and
hypertensive
retinopathy were
reviewed. 68.1% of
the cats were
referred because of
vision loss; retinal
detachment,
hemorrhage, edema,
and degeneration
were common
findings. Amlodipine
decreased BP in 31
of 32 cats and
improved ocular
signs in 18 of 26
cats. Primary
hypertension in cats
may be more common
than currently
recognized.

In a study at the
Department of Small
Animal Clinical
Sciences, College of
Veterinary Medicine,
University of
Florida, amlodipine
was shown to be a
safe and effective
once-daily
antihypertensive
agent when
administered to cats
at a dosage of 0.18
+/- 0.03 mg/kg daily
as monotherapy.
Researchers at the
Department of
Medical Sciences,
University of
Wisconsin-Madison,
administered
amlodipine at an
oral daily dosage of
0.625 mg per cat
(range = 0.08 to
0.23 mg/kg body
weight). Average
indirect systolic
blood pressure
measurements in
those 12 cases
decreased
significantly from
198 to 155 mmHg
during amlodipine
treatment.
Significant changes
in body weight and
serum creatinine and
potassium
concentrations were
not detected.

Relationship
between ocular
lesions and
hypertension

Retinal lesions,
caused predominantly
by choroidal injury,
are common in cats
with hypertension.
Hypertension should
be considered in
older cats with
acute onset of
blindness; retinal
edema, hemorrhage,
or detachment;
cardiac disease; or
neurologic
abnormalities. Cats
with
hypertension-induced
ocular disease
should be evaluated
for renal failure,
hyperthyroidism,
diabetes mellitus,
and cardiac
abnormalities. Blood
pressure
measurements and
funduscopic
evaluations should
be performed
routinely in cats at
risk for
hypertension
(preexisting renal
disease,
hyperthyroidism, and
age > 10 years).

Am J Vet Res
2002
Jun;63(6):833-9

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Vet Med
Assoc 2000 Sep
1;217(5):695-702

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Vet Intern Med
1998
May-Jun;12(3):157-62

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Anim Hosp
Assoc 1997
May-Jun;33(3):226-34

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

DERMATOLOGICS
:

Alternative
Therapies for Atopy
Dogs with atopic
dermatitis (AD)
often have
concurrent allergies
and are prone to
relapsing skin and
ear infections,
which significantly
contribute to their
discomfort level.
Much research has
been done in recent
years to identify
effective and safe
alternative
treatments.
Percutaneous
absorption of
allergens may be the
most relevant route
of exposure in dogs.
Topical therapy may
reduce the amount of
allergen absorption
through the skin.
Several
preparations,
including
glucocorticoids and
anesthetics, can be
used to reduce
pruritus and provide
analgesia.
Cyclosporine,
misoprostol,
pentoxifylline, and
various
antihistamines have
been effective.

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Vet Med
Assoc 1992 May
15;200(10):1497-500

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Antihistamines
in Horses
Practitioners may
prefer to use
antihistamines to
reduce urticarial
reactions and reduce
pruritus in horses
because these drugs
usually have fewer
side effects than
steroids. The
American Quarter
Horse Association
recommends a 10 day
withdrawal prior to
any competition.

Vet Prac News,
Apr 2001

Prednisone
Administered as a
Transdermal Gel to
Treat Allergic
Dermatitis in a CatSubmitted by
Janna L. Love,
Pharm.D.

The cat had
previously been
treated with oral
prednisone tablets.
As the owner was
unable to “pill the
cat”, she had tried
to crush the tablets
and mix with milk or
tuna juice, but the
cat still would not
take the medication.

It has been our
experience that
transdermal gels
work wonderfully in
cats. An owner does
not have to fight
the animal to get a
tablet down the
cat’s throat, and
does not have to
worry about whether
the animal has
received the correct
dose, as the
prescribed amount of
gel can be massaged
into the vascular
surface inside the
cat’s ear.

The veterinarian
prescribed
Prednisone 5 mg/0.1
ml in a transdermal
gel. We dispensed 3
ml, with
instructions to
apply 0.1 ml (5 mg)
daily to the inside
of the cat’s ear.
The benefits of
transdermal
administration
include the ability
to reliably
administer the
prescribed dose, and
ease of
administration to a
calm, relaxed cat.

The therapy was very
successful. The
cat’s dermatitis
resolved and the
hair began to regrow
within a few weeks.
There were no
complications and no
modification in
dosage was
necessary. The owner
periodically uses
the preparation when
she first notices
signs of a relapse.
Relapses have
promptly resolved
with transdermal
prednisone therapy.

ENDOCRINOLOGY :

PZI and
Low-Dose Insulin
The commercial
production of
traditional beef
&/or pork insulins
has declined as most
human diabetic
patients (the
majority of the
consumers) are being
switched to human
insulin products
because of the
reduced risk of
allergic reactions.
Protamine zinc
insulin occurs as a
sterile suspension
of insulin modified
by the addition of
protamine sulfate
and zinc chloride,
and has a long
duration of action
(up to 30 hours).
Therefore, treatment
of many dogs and
cats has been
accomplished with
once daily dosing of
PZI.
U-20 and U-40
insulin allow for
more accurate
measurement of
smaller doses
required by many
pets and birds. Use
of U-100 insulin can
result in morbidity
or mortality caused
by dosing errors.

Please call our
compounding pharmacy
for more information
about these insulin
preparations for
animals.

Oral
Anti-Diabetic Drugs
“may be appropriate
for cats that are in
good overall health
with early or mild
clinical signs of
diabetes and those
with owners who are
unwilling or unable
to administer
insulin injections.”1
The oral
hypoglycemic
medication,
glipizide, provides
a viable therapeutic
alternative to
conventional insulin
therapy with a
positive therapeutic
response in
approximately 50% of
diabetic cats with
non-insulin-dependent
disease. Response to
glipizide therapy or
lack thereof usually
is evident within
the first 4 to 6
weeks of treatment.
Adverse side effects
occurred in less
than 10% of
patients. The
existence of
residual beta cell
function is
necessary for
response to
glipizide therapy.
Discontinuation of
diabetogenic
medications that may
be contributing to
insulin resistance
is important.2

According to Deborah
S. Greco, DVM,
Ph.D., diplomate
ACVIM, glipizide has
been used
successfully to
treat diabetes
mellitus in cats at
a dosage of 2.5 to 5
mg two times daily,
when combined with
dietary fiber
therapy. Dr. Greco
recommends
evaluating the
patient weekly or
every two weeks for
a period of 2 to 3
months. If the
fasting blood sugar
decreases to less
than 200 mg/dL, the
glipizide should be
continued at the
same dosage and the
cat reevaluated in 3
to 6 months. If the
fasting blood
glucose remains >200
mg/dL after 2 to 3
months of therapy
and the cat is still
symptomatic
(polyuria,
polydipsia, weight
loss), glipizide
should be
discontinued and
insulin therapy
instituted. If the
blood glucose
remains >200 mg/dL
and the cat becomes
asymptomatic,
glipizide should be
continued
indefinitely and the
cat rechecked in 3-6
months.3

In order to access the
PubMed abstract of this
article, visit thiswebsite link.3
presented at the
1999 Southern
California VMA
Seminar and the
116th Indiana VMA
Seminar

Methimazole
for Feline
Hyperthyroid Disease
“Methimazole is the
drug of choice for
the medical
management of feline
hyperthyroid
disease. It is safer
and more potent than
propylthiouracil in
blocking thyroid
hormone synthesis.
Use of the drug
generally will bring
serum T4 into normal
ranges within 2 to 3
weeks... Adverse
effects have been
observed in
approximately 15% of
cats and generally
are transient.
Anorexia, vomiting,
and transient
lethargy have been
reported. Serum
antinuclear
antibodies develop
in many cats with
long-term use of the
drug. A
glucocorticoid-responsive
pruritus involving
the face, ears, and
neck may occur. In
less than 2% of
cases,
thrombocytopenia or
agranulocytosis have
been reported in
cats treated with
[methimazole].
Withdrawal of the
drug and provision
of care for
thrombocytopenia or
agranulocytosis
generally results in
resolution... Cats
on chronic
methimazole therapy
should be rechecked
every 3 to 6 months
to assay serum T4
levels and to check
for signs of drug
toxicity.”

According to the
International
Journal of
Pharmaceutical
Compounding (Vol. 5,
No. 2, March/April
2001, p. 96), “it
could be theorized
that transdermal
administration would
produce a ... higher
blood level of
methimazole than
that resulting from
oral administration
of the drug. A
higher blood level
of [methimazole]
might result in a
slightly greater
risk of adverse
effects, so drug
therapy might need
to be initiated at a
slightly lower dose
than that of the
traditional oral
dose.” The author of
the article (GiGi
Davidson, R.Ph.,
DICVP, North
Carolina State
University, College
of Veterinary
Medicine) states
that anecdotal
evidence indicates
that this is true of
“most transdermally
administered doses
of methimazole. The
most measurable
parameter for
efficacy is the
response of the
serum T4 level.”

Note:
Methimazole is also
used to decrease
renal toxicity of
cisplatin in dogs.

The following six
cats have received
methimazole in a
pluronic lecithin
organogel (PLO)
which the owners
apply to the inner
side of the ear.
Overall, we have
found this to be
very effective
therapy with good
compliance.
Transdermal
administration can
be particularly
helpful for owners
who have arthritis
and those who have
great difficulty
“pilling” the cat.
Methimazole doses
have ranged from
2.5mg to 12.5 mg
daily, divided into
two doses.

Cat #1 (S.A.): 17
years old, has been
on methimazole
1.25mg/0.1 ml PLO to
inside of ear twice
daily for nine
months. The owner
reports that the
medicine is easy to
administer and
absorbs well. I am
pleased with the
clinical results.

Cat #2 (A.L.): 18
years old, has been
using methimazole
for six months. This
cat was started on
3.5mg/0.1ml PLO BID.
Several dosage
adjustments were
necessary. We
increased the
concentration of the
transdermal gel to
5.0mg/0.1ml PLO, and
the owner now
applies 7.5mg/0.15ml
PLO in the AM and
5mg/0.1ml in the PM.
She places plastic
wrap over her finger
before applying the
medication, which
she has found to be
much easier to use
than pills, with no
stress to the pet.
She states the
measurements on the
topical dispenser
are easy to read,
and she needs to
wash the cat’s ear
to remove the
coating left by the
medication.

Cat #3 (B.M.): was
started on
methimazole eight
months ago at
5mg/0.1ml PLO BID.
The dose was
decreased to 2.5mg
BID. The cat’s owner
stated the
medication was very
easy to use. B.M.
improved clinically
and gained weight,
and is no longer on
the med.

Cat #4 (S.O.): used
medication once
only.

Cat #5 (D.O.): same
owner as cat #4,
received methimazole
2.5mg/0.05ml PLO BID
for two months. No
longer on
medication.

Cat #6 (M.B.): 19
years old, has
received methimazole
1.25mg/0.1ml PLO BID
for four months. The
owner says the
medication is easy
to apply, and
alternates ears. It
is necessary to wipe
the ear each day as
the medication does
leave a residue.

Adrenal
Disease in Male
Ferrets
Adrenal gland
disease is a common
problem in
middle-aged to older
ferrets. The disease
results in one or
both of the adrenal
glands producing
abnormal amounts of
androgens and/or
estrogens, and can
cause hair loss,
itching, vulvar
enlargement in
females, prostate
enlargement in male
ferrets which can
block the flow of
urine, and in rare
cases, bone marrow
suppression.
Although not usually
a serious health
concern, ferrets may
have no relief from
the itching that is
associated with this
disease if it is not
treated.
Flutamide is an
androgen blocker
that may help
relieve prostatic
enlargement. It is
dosed at 10 mg/kg,
PO, every 12-24
hours. Liver enzymes
should be checked at
one month and every
six months
thereafter. Mitotane
may be effective in
younger ferrets but
may cause nausea and
lethargy.
Ketoconazole is
usually ineffective.1

1
Evelyn Ivey, DVM,
Dip ABVP, San Diego
Co VMA Conf Procd,
Sep 2000

Mitotane for
Canine
Hyperadrenocorticism
In veterinary
medicine, mitotane
is used primarily
for the medical
treatment of
pituitary-dependent
hyper-adrenocorticism
(PDH) and palliative
therapy of adrenal
carcinoma, usually
in dogs. Systemic
drug availability
has been found to be
very poor from
intact tablets in
fasted dogs, and
best when the
powdered drug is
mixed in oil and
poured on dog food.
The interaction
between food and
mitotane probably
contributes to the
variation in
clinical response of
dogs treated with
the drug, because it
appears that the
efficacy is improved
considerably when
the drug is given
with food. Because
of the potentially
severe toxicity
associated with
mitotane, clients
should be instructed
to wear gloves
during and wash
their hands after
administering the
medication, and to
keep the medication
out of reach of
children or pets.
Dogs with concurrent
diabetes mellitus
may have rapidly
changing insulin
requirements during
the initial
treatment period,
and should be
closely monitored
until they are
clinically stable.
Clients should be
advised of the
symptoms of acute
hypoadrenocorticism.
Because of the
potential severe
toxicity associated
with mitotane,
clients should be
instructed to wash
their hands after
administration and
to keep the
medication out of
reach of children or
pets.

Therapy for
Chronic Canine
Otitis
Treatment errors,
over and under
treatment, or
inappropriate use of
antimicrobial
medication can
result in a
chronically diseased
ear. The key to
successful
management of
chronic canine
otitis is early
intervention,
identifying a cause
of the condition,
and employing
specific and
appropriate therapy.

Ears with highly
proliferative,
chronic disease
require deep
cleaning and
flushing before any
topical therapy can
be expected to help
resolve the
condition. Should a
myringotomy be
performed, the
contents of the
middle ear can be
aspirated as soon as
rupture occurs, and
the middle ear can
be flushed with
normal saline or
Tris-EDTA using a
feline, open-tipped
urinary catheter.
"Just before the
animal wakes,
Tris-EDTA and a
topical
antimicrobial
solution should be
instilled and a
parenteral
prednisolone
administered."

"The pathogens
isolated most
frequently from
chronic external and
middle-ear
infections include
Staphylococcus
intermedius,
Malassezia
pachydermatis,
Pseudomonas species,
Proteus species,
Escherichia coli,
and enterococcus.
Selection of both
systemic and topical
antimicrobial
medication is based
on cytologic
evaluation and
culture and
sensitivity results.
Systemic antibiotics
are mandatory...
Treatment should
continue until the
infection is
resolved (a minimum
of 4 weeks). It is
not uncommon for
treatment of otitis
media to continue
uninterrupted for 8
to 12 weeks."

Importance of
Medication Vehicle
Topical
antimicrobial
therapy is an
important part of
the treatment
regimen, and the
vehicle is as
important as the
active ingredient.
Most otic
preparations are
combination drugs
(glucocorticoid plus
antibiotic) in an
oil or ointment
base. Oils and
ointments are
occlusive, may hold
or trap exudate, and
may increase the
risk of ototoxicity;
such preparations
are not desirable in
cases of chronic
otitis in which a
moist exudate is
present, the canal
is stenotic, or the
eardrum may be
ruptured. The goal
of treating a wet
ear is to dry it.
Solutions and
suspensions are
primarily composed
of water; may
contain an
astringent (e.g.,
aluminum acetate);
and are designed to
evaporate over time,
thus helping to dry
the ear." Topical
antibiotics that are
selected initially
should be adjusted
when the culture and
sensitivity results
are known.

"There is no single
topical otic
preparation that
will satisfactorily
treat all
conditions.
Practitioners tend
to dispense a
product based on
clinical impressions
or pick a favorite
product rather than
selecting one that
has specific
application for the
current condition."
Direct application
of medication to the
ear canal will
result in a higher
concentration than
that obtained with
systemic medication.

Once you have
identified the
problem, we can
compound an otic
preparation to most
appropriately treat
each animal.

Compendium on
Continuing Education
21:8 August 1999,
pgs. 716-728

Antimicrobial/Anti-inflammatory
Otic Suspensions,
Anhydrous
Preparations without
Aminoglycosides
It is desirable to
move away from
commercially
available
aminoglycoside-
antifungal-steroid
otic preparations to
avoid animoglycoside
induced ototoxicity.
Use of a formulation
that substitutes a
fluoroquinolone for
an aminoglycoside
constitutes a more
effective and less
toxic therapy, and
is preferred if a
tympanum rupture is
expected. The
efficacy and
tolerability of a
fluoroquinolone-clotrimazole-dexamethasone
(FCD) otic
suspension (10 drops
per affected ear
once daily) was
compared with a
standard topical
treatment containing
polymyxin B,
miconazole and
prednisolone (PMP)
in a total of 140
dogs with clinical
signs of acute or
subacute otitis
externa,
Staphylococcus,
Pseudomonas,
Enterobacteriaceae
and Malassezia were
isolated from
samples taken at
inclusion. Each
group received
treatment for 7 or
14 days according to
the clinical outcome
on day 7. Treatments
were equally
effective, with a
cure rate of 58.3%
for the FCD prep and
41.2% for the PMP
combination. Both
medications were
equally well
tolerated by dogs,
but FCD was superior
in terms of pain
relief, decrease in
pus quantity and
smell, response rate
and investigator's
assessment on day
14.

While it is a common
practice in some
veterinary offices
to add dexamethasone
injection to
clotrimazole
solution to create
an otic preparation
with both antifungal
and
anti-inflammatory
properties, it is
more desirable to
use an anhydrous
preparation in the
ear to reduce the
risk of bacterial
growth in the warm,
moist environment.
Anhydrous
preparations also
tend to have longer
shelf lives. Avoid
using products such
as miconazole
solution which has a
high alcohol
concentration to
avoid irritating a
sensitive ear.

Contact
our compounding
pharmacy for
anhydrous otic
preparations.

Helpful
Hints Regarding
Otitis Therapy
Ototoxicity
manifested as
deafness or
vestibular toxicity
is a potential
adverse effect of
some medications
used to treat
otitis, such as
aminoglycosides
(tobramycin,
gentamicin, amikacin
and neomycin) and
chloramphenicol.
Numerous
alternatives exist.

Enrofloxacin, a
fluoroquinolone
effective against
Pseudomonas species,
can be compounded as
a solution and
applied to the ear
canal twice daily.
"Topical
enrofloxacin may
achieve a higher
antibiotic
concentration at the
site more
economically than
systemic
medication."

Silver sulfadiazine
is effective in
vitro against
Pseudomonas species,
Staph aureus,
Proteus species, and
others; a 0.1% to 1%
emulsion every 12
hours is adequate to
kill Pseudomonas.

Topical otic
products may contain
potent
glucocorticoids in
ointment or oil
bases. However,
solutions may be a
preferable vehicle,
and it may be
advisable to use a
less potent steroid
because the degree
of absorption of
topical steroids can
not be controlled.
We can compound a
preparation
containing your
choice of steroid in
the most appropriate
vehicle to treat the
condition.

"Commercial otic
drying agents should
be avoided in
inflamed,
chronically diseased
ears because most
contain isopropyl
alcohol and varying
concentrations of
benzoic, acetic,
salicylic, or boric
acid. Each of these
products
individually can be
extremely irritating
to an already
traumatized
epithelium."

Acetic acid solution
can be used to
decrease the
bacterial population
by lowering the pH
within the ear
canal. Pseudomonas
can be killed by 1
minute of contact
with a 2% solution.
This treatment is
especially
beneficial when the
organism is
resistant to other
antibacterials.
Staph and Strep may
be killed by 5
minutes of contact
with a 5% solution,
according to Kirk's
Current Veterinary
Therapy XII Small
Animal Practice.
However,
inflammation (which
can be severe) is an
occasional side
effect of treatment
with acetic acid
concentrations
higher than 2.5%.

The common therapy
for fungal otitis
externa in dogs
utilizes an
antifungal and
topical steroid,
sometimes in
combination with
systemic
antibiotics. The
three organisms
which have been
isolated and are
thought to be the
most common
pathogens in
recurrent canine
otitis externa are
Malassezia,
Pseudomonas, and
Proteus spp. Using a
fluoroquinolone
along with an
antifungal, we are
able to have good
coverage on all
virulent pathogens.
For treatment of
resistant
infections, the
synergism of
norfloxacin and
ketoconazole
provides a broader
spectrum of coverage
than many other
therapies, as
ketoconazole is a
more active
antifungal than
clotrimazole. We
have utilized a
compounded otic gel
containing
norfloxacin 1% and
ketoconazole 1% more
than 20 times with a
very high success
rate.

Infectious otitis
externa is a common
disease in dogs.
Systemic antibiotic
therapy is not
always required.
Thirty-six dogs of
mixed sex, breed,
and age were treated
for... the purpose
of evaluating the
efficacy of a
ketoconazole 1% and
norfloxacin 1% otic
gel... Treatment
consisted of 0.5 to
1.0 ml of the otic
gel in each affected
ear twice a day for
7 days. Results
showed 91.66%
satisfactory
responses at 7 and
14 days treatment...
Failures (8.33%)
were related to
Staphylococcus
associated with
Proteus, Malassezia,
and Candida... The
7-day treatment was
successful in 21
cases. However,
since 12 dogs
required 14 days of
treatment, it would
be sensible to
recommend a 14-day
therapy."

authors reported the
successful use of
Tris-EDTA in the
treatment of otitis
externa. In 24 dogs
with clinical
otitis, the
Tris-EDTA
(tris[hydroxymethyl]
aminomethane and
ethylenediaminetetraacetate)
combination was
tested against
Bacillus spp.,
Staphylococcus
aureus, Candida
spp., Pseudomonas
aeruginosa,
Esherichia coli,
Proteus vulgaris,
Trichosporon spp.,
and an
a-streptococcus.
"Fifteen of the 24
cases were acute;
all were evaluated
with bacterial
culture before and
after treatment. The
treatment consisted
of applying lavage
solution to the ears
t.i.d. until
resolution or for
three weeks if there
was no clinical
response. Dogs were
examined for
irritation of the
ears after
treatment... 23 of
24 cases were
resolved; no adverse
effects were seen,
but duration of
follow-up was not
specified. The case
that failed to
respond was a
chronic, mixed
infection of E. Coli
and Proteus spp.;
inflammation was
reduced, but the
infection persisted.
Most cases responded
within one week, but
P. aeruginosa
infections required
one to three weeks
of treatment."

Veterinary
Forum, June
1999, p. 52

Tris-EDTA solution
(buffered to pH 8.0)
has a direct
bactericidal effect
on some bacteria by
chelating metal ions
in the cell wall.
"Dogs with chronic
disease (e.g. atopy,
idiopathic
seborrhea) will be
predisposed to
recurrent otitis; a
topical antibiotic
solution or
Tris-EDTA used two
to three times
weekly may prevent
an infection from
occurring with each
flare-up of the
primary disease."

The bactericidal
effects of Tris-EDTA
are synergistic with
aminoglycosides.
Although an
antibiotic can be
added to the
Tris-EDTA solution,
Patricia D. White,
DVM, MS states that
she prefers to use
Tris-EDTA 5 to 10
minutes before the
topical antibiotic.
The
Tris-EDTA/antibiotic
combination is
ineffective against
yeast.

Compendium on
Continuing Education
21:8 Aug. 1999, pgs.
716-728

PAIN MANAGEMENT
:

Pain
Management in Cats
Pharmacokinetic data
developed in other
species cannot be
safely extrapolated
to the cat. Feline
deficiency of
glucuronidation
pathways results in
slow metabolism of
several NSAIDs,
which prolongs the
duration of effect
and may lead to drug
accumulation and
toxicity.

Meloxicam, a COX2
selective NSAID, has
demonstrated
clinical efficacy
for chronic pain,
musculoskeletal
pain, and routine
soft tissue surgery
with few side
effects. Based on
clinical experience,
Lascelles of NCSU
College of
Veterinary Medicine,
now recommends oral
meloxicam doses for
cats that are less
than previously
reported in the
literature (0.1
mg/kg PO on day 1
followed by 0.05
mg/kg PO daily for
4-6 days, then 0.025
mg/kg daily for 10
days, then lowest
effective dose).1

Five days of oral
treatment with
meloxicam or
ketoprofen for cats
with painful
locomotor disorders
provided similar
analgesia2,
but meloxicam drops
were more palatable
than ketoprofen
tablets.
Appropriately
flavored
preparations in a
convenient dosage
form are easier for
owners to administer
and allow for
accurate dosing.

According to
Robertson and Taylor3,
opioids have an
unjustified
reputation for
causing mania in
cats, but with
refinements in
dosing they are now
used successfully in
this species. The
mu-opioid agonists
are generally
considered the best
analgesics. Morphine
(0.1–0.3 mg/kg) is
effective in a
clinical setting.
Oxymorphone and
hydromorphone
(0.05–0.1 mg/kg) are
widely used in the
USA. These opioids
are more potent (up
to 10 times), and
longer acting than
morphine in cats.
Buprenorphine
(0.01–0.02 mg/kg), a
partial mu-agonist,
is the most popular
opioid used in small
animal practice in
the UK, other parts
of Europe, Australia
and South Africa. In
clinical studies it
has produced better
analgesia than
several other
opioids and appears
to be highly
suitable for
perioperative pain
management in cats.

Amitriptyline
(starting dose 2.5
mg/kg PO, once
daily) has been used
to treat feline
interstitial
cystitis with few
side effects, and
there are anecdotal
reports of its use
for cancer and
neuropathic pain
management.

Some of the less
conventional
analgesics including
the tricyclic
anti-depressants and
gabapentin may prove
to play a useful
role in chronic pain
management, but
controlled clinical
trials are needed to
establish the best
doses for maximum
efficacy. Other less
traditional
analgesics such as
ketamine and local
anesthetics are also
used for clinical
pain management. The
transmucosal,
transdermal and
epidural routes
offer novel methods
for administration
of analgesic drugs
and have
considerable
potential for
improving techniques
in feline pain
management.

In order to access the
PubMed abstract of this
article, visit thiswebsite link.3Journal
of Feline Medicine
and Surgery;
6(5), Oct 2004:
321-333

Meloxicam
for Analgesia in
DogsA clinical
trial was conducted
to evaluate the
safety and efficacy
of meloxicam
in dogs with chronic
osteoarthritis. A
scoring system
assessed specific
lameness, general
stiffness, painful
rise, exercise
intolerance, and
behavior, and
demonstrated
significant
reductions in
clinical signs of
osteoarthritis
following 4 weeks of
drug therapy. Side
effects were minimal
in extent and
duration. The
findings of this
investigation
suggest that the
efficacy, tolerance,
and formulation of
meloxicam oral
suspension make it
well suited for the
treatment of chronic
osteoarthritis in
the dog.

Can Vet J
2000
Apr;41(4):296-300

Ketoprofen
is a potent
anti-inflammatory
and analgesic which
can be used for the
management of
surgical pain or
chronic pain. The
drug should not be
given to animals
with GI ulceration,
impaired renal or
hepatic function, or
coagulation
disorders.
Ketoprofen should
not be used
preoperatively when
noncompressible
bleeding may be a
problem. Occasional
vomiting has been
reported. When an
NSAID or other drug
that is potentially
irritating to the GI
tract is needed,
topical preparations
offer an excellent
alternative.
Pharmaceutical
Research, Vol. 13,
No. 1, 1996
reports (in humans)
“a topical
formulation of
ketoprofen
has been developed
for the temporary
relief of minor
aches and pains of
muscle and joints
and to minimize
gastrointestinal
side effects after
oral
administration.”

POISONING /
TOXICOSIS
:

Xylitol
Poisoning in Dogs
Compounding
pharmacists are now
receiving requests
from veterinarians
to compound oral
medications for dogs
and cats in vehicles
that are known to be
free of xylitol.
Xylitol is an
artificial sweetener
commonly used to
sweeten human
medications, gums,
mouthwashes and
candies, and while
not toxic to humans,
can be quite toxic
to dogs. Xylitol is
not absorbed from
the gastrointestinal
tract of humans, but
is easily absorbed
in dogs. Once in the
bloodstream, xylitol
acts like glucose,
stimulating insulin
secretion, which
causes
life-threatening
hypoglycemia.
Profound
hypoglycemia can
last for 1-2 hours
following xylitol
ingestion, and has
frequently resulted
in death. Many
commercially
available drugs
labeled for humans,
such as gabapentin
oral suspension,
contain xylitol as
an inactive
ingredient, and all
human medications
used in dogs should
be scrutinized for
xylitol content.
Compounding
pharmacists can play
a valuable role for
veterinarians and
veterinary patients
by providing
xylitol-free
suspensions of
medications
and by educating
clients to avoid all
xylitol-containing
foods in their pets.
It is not currently
known if xylitol is
toxic in cats, but
for the present,
xylitol must also be
assumed to be toxic
to cats. For more
information, search
"xylitol" at
http://www.aspca.org.

Apomorphine
to Stimulate
VomitingEmetic
drugs are usually
administered in
emergency situations
after ingestion of a
toxin. "Apomorphine
is an opiate drug
that acts as a
potent central
dopamine agonist to
directly stimulate
the CTZ. It can be
administered PO, IV,
or SC; the IM route
is not as effective.
It can also be
applied directly to
conjunctival and
gingival membranes,
using the tablet
formulation, which
can easily be
removed once emesis
is initiated.
Vomiting usually
occurs in 5-10 min.
Although apomorphine
directly stimulates
the CTZ, it has a
depressant effect on
the emetic center.
Therefore, if the
first dose does not
induce emesis,
additional doses are
not helpful. Because
the vestibular
apparatus may also
be involved in
apomorphine-induced
vomiting, animals
that are sedate and
motionless will not
vomit as readily as
animals that are
active. Because it
can cause CNS
stimulation,
apomorphine is used
cautiously in cats.
Opiate-induced
excitement in cats
can be treated with
naloxone (an opiate
antagonist)." Apomorphine
dosage for dogs:
4 mg/kg PO;
0.02 mg/kg IV; 0.3
mg/kg SC (from Merck
Veterinary Manual,
8th edition, p.
1681); 0.25mg/kg (as
a tablet) into the
conjunctival sac
(from Plumb's
Veterinary Drug
Handbook, p.51)

Accidental
Poisoning
"is not a rare
event; and
veterinarians need
to have access to
antidotes. However,
there are relatively
few products
specifically labeled
for use in these
instances, so it has
not really been
legal for
veterinarians to
have previously
prepared antidotes
for poisonings on
hand in emergency
rooms. For example,
if a case of lead
poisoning is
diagnosed and the
veterinarian needs
some calcium EDTA as
an antidote, there
is no product
available labeled
for use in
animals...
Compounding offers
opportunities for
facilities to have
[items such as
calcium EDTA] on
hand ... for
emergency treatment,
in anticipation of a
legitimate
prescription." Intl J of Pharm
Comp 1997
July/Aug; 1(4): 240

N-acetylcysteine as
an Antidote for
Acetaminophen
Toxicosis
N-acetylcysteine
(NAC) is the
antidote of choice
for the treatment of
acetaminophen
poisoning, one of
the most common
types of
intoxication in dogs
and cats. NAC acts
principally by
replenishment of
intracellular
glutathione stores
and detoxification
of the reactive
metabolite (NAPQI).
NAC acts as a
scavenger of free
radicals, blocks the
conversion of
hemoglobin to
methemoglobin, and
can reduce the
extent of liver
injury.

Although NAC is most
effective if
administered less
than 12 hours after
ingestion of
acetaminophen, the
use of NAC as an
antidote is still
recommended up to 36
to 80 hours after
acetaminophen
ingestion.

Oral NAC, IV NAC,
and IV sodium
sulfate were
evaluated as
treatments for cats
who had received
toxic sublethal
doses of
acetaminophen
(APAP). At the
dosage levels used,
oral NAC, IV NAC,
and IV sodium
sulfate were equally
effective antidotes,
as measured by
decreased
methemo-globinemia,
increased whole
blood reduced
glutathione,
decreased APAP
half-lives, and
increased urinary
excretion of the
APAP-sulfate
conjugate. All the
antidotal treatments
produced results
significantly
different from those
in the control cats.

To determine if
rectally
administered
N-acetylcysteine
(NAC) is absorbed
into the systemic
circulation, NAC was
administered into
the rectal vault
(2.0 g/kg) of swine
via a balloon-tipped
Foley catheter
inserted into the
animals' rectums.
NAC administered via
the rectal route
resulted in systemic
absorption as
determined by
spectrophotometric
methods in 5 of the
7 study animals.
This study provides
important
information
regarding the
development of a
potential
alternative route
for the
administration of
NAC to dogs.

In dogs and cats,
NAC can be
administered
intravenously or
orally, but has a
pungent odor. Oral
administration of
NAC typically causes
nausea and vomiting.
The oral solution
can be compounded as
a chicken-flavored
preparation to
improve
palatability.

Rapid intravenous
administration of
NAC can cause
hypotension,
bronchospasm, and
flushing. Reactions
can be minimized by
slowing the rate of
infusion.

Activated charcoal
may absorb NAC and
reduce its
effectiveness, so
NAC should not be
administered within
two hours of giving
activated charcoal.
"Administration of
activated charcoal
may exacerbate
vomiting and lead to
aspiration. A strong
antiemetic agent
(metoclopramide 0.4
mg/kg IV) may be
necessary to prevent
emesis."

NAC is currently not
approved by the FDA
for use in dogs and
cats, but is
available in human
formulations, and
upon a prescription
order, can be
compounded to meet
specific veterinary
needs.

Compendium
2003
Apr;25(4):276-280Am J Vet Res
1985
Jul;46(7):1485-9

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

The owners of two
nine-year-old cats
moved to a new
house. One week
after moving, both
cats were vomiting
and losing weight so
the owners brought
the cats to the
veterinary clinic.
The veterinarian
began intravenous
hydration. Blood
work showed a very
high level of
nucleated RBC's. The
CBC revealed
platelet clumps on
feathered edge, few
macrocytes, moderate
anisocytosis, and
occasional
acanthocytes (54%
and 45.1% NRBC). One
cat had two seizures
on the first day of
hospitalization.
Based on the initial
signs and nucleated
red cells, lead
poisoning was
suspected, although
there was no
radiographic
evidence of lead
ingestion. We tested
for lead and began
treatment with
dimercaptosuccinic
acid (DMSA) 40mg/cc.

The cats improved
clinically within 24
hours. There were no
more seizures and
the cats began to
eat. The blood lead
levels were 164.8
and 210 (normal is
0-25). The cats were
treated with 40mg
(1cc) of DMSA given
orally three times
per day for a total
of 10 days. DMSA is
not commercially
available in an
injectable or liquid
form. Therefore, we
worked together with
our compounding
pharmacist to
prepare a sterile
formulation that
would be suitable
for intravenous or
oral use.

The second day after
therapy had begun,
the owners informed
us that they had
been sanding the
painted floors in
their new house. The
cats probably walked
through the dust and
in grooming
themselves licked
the lead paint off
their paws. There
have been no further
problems with the
cats to our
knowledge. The owner
declined to come in
for a lead level
recheck.

Penicillamine for
Long-Term Treatment
of Lead Poisoning
Penicillamine
chelates a variety
of metals, including
copper, lead, iron
and mercury, forming
stable water-soluble
complexes that are
excreted by the
kidneys. Used
primarily for its
chelating ability in
veterinary medicine,
it is the drug of
choice for copper
storage-associated
hepatopathies in
dogs at a dose of
15mg/kg PO twice
daily. Penicillamine
may also be used in
cystine urolithiasis
(penicillamine
combines chemically
with cystine to form
a stable soluble
complex that can be
readily excreted)
and in a different
dose for the
long-term oral
treatment of lead
poisoning. "This
drug should
preferably be given
on an empty stomach,
at least 30 minutes
before feeding. If
the animal develops
problems with
vomiting or
anorexia, three
remedies have been
suggested. 1) Give
the same total daily
dose, but divide
into smaller
individual doses and
give more
frequently. 2)
Temporarily reduce
the daily dose and
gradually increase
to recommended
dosage. 3) Give with
meals (will probably
reduce amount of
drug absorbed)."

Veterinary Drug
Handbook, 2nd
edition, Donald C.
Plumb, Ed.

4-Methylpyrazole for
Ethylene Glycol
(Antifreeze)
Poisoning Therapy for
ethylene glycol
poisoning is aimed
at preventing
absorption,
increasing
excretion, and
preventing
metabolism of
ethylene glycol to
its toxic
metabolites.
Inhibition of liver
alcohol
dehydrogenase (ADH),
the enzyme
responsible for the
initial reaction in
the metabolic
pathway, can be
accomplished by
giving a compound
that combines with
the enzyme and
renders it inactive.
The most effective
ADH inhibitor in the
dog is
4-methylpyrazole
(4-MP), which unlike
most competitive
inhibitors (ethanol,
propylene glycol,
and 1,3-butanediol)
does not contribute
to CNS depression
and increased serum
osmolality. The
recommended dose of
5% (50mg/ml)
4-methylpyrazole is
20 mg/kg body weight
IV initially,
followed by 15 mg/kg
IV at 12 and 24 hr,
and 5 mg/kg at 36
hr. While 4-MP is
the recommended
therapy in dogs, it
is not appropriate
for use in cats.
Although it is
non-toxic, it does
not effectively
inhibit EG
metabolism unless
administered to a
cat at the same time
as consumption of
EG.

Potassium bromide is
frequently helpful
in treating
refractory seizures
in animals. Because
potassium bromide is
excreted renally, it
may also be
preferable for use
in animals that have
developed
hepatotoxicity while
on other
anticonvulsants. My
compounding
pharmacist prepares
this as a liver
flavored solution,
which can easily be
administered to
dogs. I feel that it
is important to
inform my animal
owners that
potassium bromide
solution is
compounded from a
reagent grade
chemical, and is not
a commercially
available “drug.”

KBr is dosed on a
weight basis.
Maintenance doses
range from 20-100
mg/kg body
weight/day, and can
be given as a single
or divided dose. I
usually dose at
30-40mg/kg/day as a
single dose with
food. Due to its
long half-life, KBr
can take up to four
months to reach
steady state;
therefore, a loading
dose may be required
if therapeutic blood
levels must be
reached quickly. The
loading dose is
400-600 mg/kg body
weight and is
administered orally
over 30 to 60
minutes to avoid
vomiting. A loading
dose is not
necessary if it is
possible to keep the
animal on other
medications (as in a
case of emerging
hepatotoxicity)
until levels of
bromide are
therapeutic (0.5-1.5
mg/ml), when the
other anticonvulsant
can be tapered off.

Case Report: 5 y.o.
male Golden
Retriever with
seizure disorder.
The owners called
our compounding
pharmacy to see what
we could do as they
were having
difficulty
administering
medications to their
dog. We suggested
medicated canine
treats that we have
compounded many
times with a 100%
success rate. The
veterinarian was
consulted and we
prepared potassium
bromide (KBr) 150 mg
treats coated with
liver and beef
flavored powder. The
owner administers
two treats two times
daily, and the dog
now loves to take
his medicine!

Note: Chewable
treats can be
compounded to
contain a variety of
medications and
flavored for the
specific breed or
pet. This dosage
form has high
patient acceptance
and a low risk of
owner misdosing.

Potassium bromide
(KBr) can be also
compounded as an
oral solution which
is easy to flavor
and convenient for
use as a loading
dose. However, the
risk of owner
misdosing is greater
than with a chewie
or capsule.

Phenobarbital:
Problems and
Solutions
While phenobarbital
is often used in
veterinary medicine
to treat seizure
disorders, there are
several concerns
with its use:

there are no
commercially
available
veterinary
approved
products

phenobarbital
tablets for
human use are
small, hard, and
unscored, making
them difficult
to divide for
individualized
dosing

phenobarbital
elixir has a
high alcohol
content, which
is problematic
for cats or any
species when
chronically
administered

When you wish to
prescribe
phenobarbital,
please be aware that
our compounding
pharmacy can prepare
an alcohol-free,
appropriately
flavored oral
suspension, which is
highly bio-available
and very easy to use
when administering a
loading dose or when
a flexible dose is
needed. Once the
maintenance dose is
established, the
dosage form can be
switched to a
capsule (with a
lower risk of
misdosing by the
owner) or a flavored
chewable medicated
“treat”, with the
added benefit of
high patient
acceptance.

UROLOGY
:

Treatment
for Urinary
Incontinence

Hormonal
Therapy:
Diethylstilbestrol
(DES) has been used
to treat estrogen
responsive
incontinence in
spayed female dogs.
The use of DES is
contraindicated in
cats as daily use
has resulted in
pancreatic, hepatic,
and cardiac lesions.

Dose for
dogs:

Initially 0.1-1.0 mg
PO daily for 3-5
days, followed by
maintenance therapy
of approximately 1
mg PO per week. Some
animals may require
much higher initial
dosages to obtain a
response. DES can be
given PO to female
dogs at 0.1-0.3
mg/kg/day for 7-10
days, followed by a
similar dose once
weekly. Dogs should
be maintained at the
lowest possible dose
because bone marrow
suppression can
develop when
diethylstilbestrol
is given in high
doses. 1,4

When therapy is
chronic or high
dosages are used,
packed cell volumes,
white blood cell
counts, and platelet
counts should be
done at least
monthly. Liver
function tests
should be done at
baseline, one month
after therapy, and
repeated 2 months
after cessation of
therapy if abnormal.

Clients should be
informed to contact
the veterinarian if
signs and symptoms
of lethargy,
diarrhea, vomiting,
abnormal discharge
from vulva,
excessive water
consumption and
urination or
abnormal bleeding
occur. DES is not
for human
consumption and
should be dispensed
only in
child-resistant
containers and
stored in a secure
location.1

DES is not
currently
commercially
available; however,
the medication can
be prepared by a
compounding
pharmacy.

Adrenergic
Agonists:
Phenylpropanolamine
(PPA) is a weak
alphaagonist that
increases urethral
sphincter tone and
produces closure of
the bladder neck,
and is used to treat
urethral sphincter
hypotonus and
resulting
incontinence in dogs
and cats.

Dose1:

Dogs: 1.1
mg/kg PO every 8
hours
Cats: 12.5mg
PO every 8 hours

The effect is
short-lived, and the
dose needs to be
titrated to effect.
“Dogs that are older
at the onset of
clinical signs
(median 5 years) and
those with a longer
period from the time
of
ovariohysterectomy
to the onset of
urinary incontinence
(median 2.5 years)
respond best. PPA is
preferred to
ephedrine because
side effects are
less severe;
ephedrine has
greater
cardiovascular side
effects and it tends
to lose
effectiveness over
time.”2
In a multicenter,
blinded,
placebo-controlled
trial, 50 dogs that
presented with
clinical signs
consistent with
urinary sphincter
mechanism
incontinence were
treated for 28 days
with either PPA (1
mg/kg three times
daily) or placebo.
At day 28, 85.7 per
cent of PPA-treated
cases had no
episodes of
unconscious
urination compared
with 33.3 per cent
of placebo-treated
cases.3

Per your
prescription, we can
compound customized
dosage forms to meet
the specific needs
and flavor/texture
preferences of each
animal.

Piroxicam
for Canine Bladder
Cancer

Traditional
chemotherapy (using
cisplatin,
carboplatin,
adriamycin, and
others) has been
used in canine
Transitional Cell
Carcinoma (TCC). The
response has been
rather disappointing
with <20% of dogs
having remission.

Interest in
non-steroidal
anti-inflammatory
(NSAID) therapy
began when dogs with
various forms of
spontaneous cancer
had remission while
receiving the NSAID
piroxicam for pain
control, and no
other therapy.
Two of the first
dogs treated (one
with metastatic
carcinoma, one with
undifferentiated
sarcoma) had
advanced cancer and
had remission of
their cancer when
only receiving
piroxicam. This has
led to numerous
studies of piroxicam
in animals with
cancer at Purdue
University
Veterinary Teaching
Hospital (PUVTH). In
an attempt to
improve the response
of TCC to therapy,
PUVTH conducted a
study comparing
chemotherapy
(cisplatin) alone to
chemotherapy plus
piroxicam. The
combination of
cisplatin and
piroxicam was more
effective against
the cancer, but the
combination
treatment caused a
rise in BUN. In
several instances,
the cisplatin
therapy was
withdrawn (so as to
not cause renal
damage) while the
tumors were still
shrinking.

In a phase I study
of piroxicam in 62
dogs with various
histopathologically
confirmed,
measurable tumors,
gastrointestinal
toxicity was
dose-related and
dose limiting, but
anti-tumor activity
occurred at lower,
less toxic doses of
piroxicam. Partial
remission occurred
in 8 dogs, including
3 of 10 dogs with
TCC. A phase II
clinical trial of
piroxicam in dogs
with histologically
confirmed,
measurable,
nonresectable TCC
was performed. The
dogs lived at home
with their owners
and were evaluated
at the PUVTH at
monthly intervals.
Piroxicam was given
orally at a dosage
of 0.3 mg/kg every
24 hours (the
accepted canine
dosage prior to this
trial). Tumor
response in 34 dogs
included 2 complete
remissions (CR), 4
partial remissions
(PR), 18 stable
disease (SD), and 10
progressive disease
(PD). Piroxicam
therapy was
generally well
tolerated, with
gastrointestinal
toxicity noted in
six dogs and renal
papillary necrosis
in two dogs. The
median survival was
180 days. Fifty-five
additional dogs were
treated with
piroxicam, and tumor
response included 2
CR, 7 PR, 32 SD, and
14 PD.

It is not known how
long dogs with TCC
that are not treated
will live. Survival
is affected by the
growth rate of the
tumor, the exact
location of the
tumor within the
bladder, and whether
the tumor has
metasticized. The
median survival in
dogs treated with
cisplatin or
carboplatin at PUVTH
was 130 days. Median
survival with
piroxicam treatment
in 55 dogs with TCC
was 190 days. The
survival times in
all of these
studies, however,
vary tremendously
from only a few days
to more than one
year. Longer
survival times have
been reached when
chemotherapy is
combined with
piroxicam, but the
optimal combination
treatment is still
being determined.

Cancer Chemother
Pharmacol
1992;29:214-218

J Vet Intern Med
1994;8:273-278

Cancer Chemother
Pharmacol
2000;46:221-226

In order to access the
PubMed abstract of this
article, visit thiswebsite link.Urologic
Oncology
2000;5:47-59

Citrate
Salts as
Alkalinizing AgentsCitrate
salts are a source
of bicarbonate, but
are much more
palatable than
bicarbonate
preparations. “They
are used as urinary
alkalinizers when an
alkaline urine is
desirable and in the
management of
chronic metabolic
acidosis accompanied
with conditions such
as renal tubular
acidosis or chronic
renal insufficiency.
Potassium citrate
alone has been used
for the prevention
of calcium oxalate
uroliths. The
citrate can complex
with calcium thereby
decreasing urinary
concentrations of
calcium oxalate...
When urine is
alkalinized by
citrate solutions,
excretion of certain
drugs (e.g.
quinidine,
amphetamines,
ephedrine,
...tetracycline) is
decreased, and
excretion of weakly
acidic drugs (e.g.
salicylates) is
increased. The
solubility of
ciprofloxacin and
enrofloxacin is
decreased in an
alkaline environment
[and patients]
should be monitored
for signs of
crystalluria.”
(Plumb’s
Veterinary Drug
Handbook, 2nd
ed.) In
combination with
potassium citrate
preparations, these
agents may lead to
severe increases in
serum potassium
levels: NSAIDs,
ACE-inhibitors,
cyclosporine,
digitalis, heparin
and others.

Fludrocortisone
Acetate
Fludrocortisone is a
long-acting
corticosteroid with
potent
mineralocorticoid
and moderate
glucocorticoid
activity. It is used
in small animal
medicine for the
treatment of
adrenocortical
insufficiency, where
it promotes sodium
retention and
urinary potassium
secretion. It is
commercially
available only as
the human product, a
tablet containing
0.1 mg
fludrocortisone
acetate. The
maintenance therapy
for animals
(particularly dogs)
can require
administration of
multiple tablets for
each daily dose.
Therefore, it may be
more convenient for
owner and animal to
administer
fludrocortisone
acetate as a
flavored suspension,
or single flavored
solid dosage form.

Aluminum
Hydroxide for
HyperphosphatemiaFor dogs
and cats, aluminum
hydroxide is
initially dosed at
30 - 90 mg/kg orally
one to three times
daily. A preparation
that can be mixed
with food may be
preferred as it is
more easily
dispersed throughout
ingesta. Dosage must
be individualized,
and serum phosphate
levels should be
evaluated at 10-14
days to determine
optimum dosage.

Our protocol for
treating chronic
renal failure
includes a special
diet, adequate
hydration, potassium
supplementation,
stomach acid control
and calcitriol
therapy to control
phosphorus levels.
Calcitriol (a
vitamin D3
metabolite) may also
be used to prevent
or reverse secondary
hyperparathyroidism
in dogs and cats
with chronic renal
failure.

Calcitriol is dosed
in nanograms.
Commercially
available products
are for humans, and
the dose is much too
high for dogs or
cats (for example,
the capsule contains
250 nanograms or
0.25 micrograms).
Our compounding
pharmacist has been
able to prepare any
capsule (8 nanograms
and up) or liquid
(i.e. 4
nanograms/0.25ml)
necessary to meet
our needs. We
have used this
compounded remedy
over one hundred
times and have found
it to be very
successful in
lowering phosphorus
levels in our
patients with
chronic renal
failure. Serum
calcium levels
should be monitored
as hypercalcemia is
a possible
consequence of
calcitriol
administration.

Editor’s Note:

Calcitriol “has a
rapid onset of
action (1-4 days)
and a short
half-life (4-6
hours). Oral
calcitriol is
administered to
patients after
initial
stabilization with
fluid therapy,
dietary protein and
phosphorus
restriction, the use
of intestinal
phosphate binders
and H-2 blockers as
needed. Serum
phosphorus should be
less than 6 mg/dL
(1.9 mmol/liter)
before initiating
calcitriol.

“Hypercalcemia
usually only occurs
if calcitriol is
used in conjunction
with intestinal
phosphate binders,
especially calcium
carbonate...
Long-term use of
phenytoin and the
barbiturates may
interfere with the
action of the drug,
necessitating higher
doses of
calcitriol...
Thiazide diuretics
may enhance the
effects of
calcitriol
predisposing to
hypercalcemia.
Calcitriol-induced
hypercalcemia may
antagonize the
antiarrhythmic
effects of calcium
channel-blocking
agents.”

Handbook of
Veterinary Drugs,
2nd edition, pp.
105-106

WOUND CARE
:

Would you like a
topical medication
that is difficult
for an animal to
lick off or that
will adhere to a
mucosal surface?

You can prescribe a
medicated “polyox
bandage” or “mucosal
bandage”. When
moistened, this
medicated
preparation will
adhere to a wound or
mucosal surface,
thereby providing a
protective barrier
and increasing the
contact between the
medication and the
affected area.

Wound and
Incision Care -
Prevent Licking
A common problem
encountered by
veterinarians and
animal owners is
preventing an animal
from licking an
incision or licking
medication from the
area to which it has
been applied. In
addition to injury
to the wound,
pharmacists and
veterinarians must
consider the
consequences of
internal consumption
of an external
preparation. To
prevent an animal
from licking, a
medication can be
compounded to
contain an extremely
bitter substance.
Choices include
diphenhydramine,
quinine, or the
non-therapeutic
ingredient sucrose
octaacetate. Sucrose
octaacetate can be
added at 1% to 5% to
any topical dosage
form and the
bitterness usually
prevents the animal
from repeated
licking of the area
of application.
Another way to
protect a medicated
area from licking is
to incorporate the
needed medication
into CAP (Cellulose
Acetate Hydrogen
Phthlate) solution.
Since CAP solution
does not dissolve in
an acidic pH, the
animal’s saliva does
not remove it from
the skin. CAP
solution can also be
sprayed directly
onto a wound or over
stitches to protect
them.

Phenytoin/Lidocaine
Poly-Ox Bandage Used
to Treat Leg Wound
Problem: Twenty-four
hours after an
automobile accident,
an eight-month old
female pit bull
presented with a leg
injury that appeared
as if it would have
difficulty healing.
The dog had been hit
by an automobile,
which had scraped a
hole in the right
front leg. The
wound, which
extended from the
elbow to the carpus,
was approximately
3/4" to 1” wide.

Treatment: The
tissue of the leg
was stabilized using
tension-relieving
sutures. Because the
veterinarian had
prior successful
experiences with
other cases
involving wound
care, she requested
we compound a
topical preparation
consisting of 2%
phenytoin and 2%
lidocaine in a
methylcellulose/polyoxyethylene
(poly-ox) bandage
for the dog. The
animal underwent
hydrotherapy twice
daily and the
compounded
medication was
applied just before
bandaging was
secured.

Outcome: The wound
was completely
healed after 2
months of therapy
and the animal has
full use of her leg
with no visible ill
effects. According
to the veterinarian,
the animal healed
much quicker than
usual due to the
increased contact
time of the
medications and she
was satisfied with
the treatment
process.

We have also used
this compound with
the same positive
success on a
degloved feline
after its paw had
been caught in a
fence overnight.

In April 1998, I was
called to euthanize
a 1 1/2 year old
female miniature
schnauzer that had
been burned with hot
water from the bath
tub and washed in
Woolite® 3-4 weeks
earlier. The full
thickness burns
involved about 80%
of the skin on the
dorsal trunk from
neck to tail and
elbows to midthigh.
The owners were
using aloe vera to
treat the burns and
she had a severe
infection, was
emaciated (5 lb.)
and had not eaten
for one week. Since
she had survived so
long without
treatment, I had the
owners sign
ownership over to me
and I contacted the
Central Dakota
Humane Society. They
agreed to take on
this project despite
the many hours of
labor and the
potential cost. The
dog was immediately
given an analgesic
and antibiotics.

I literally stopped
at the pharmacy with
the dog so the
compounding
pharmacist could see
what we were up
against. At the
pharmacist’s
suggestion, a
Poly-Ox bandage
containing phenytoin
base 2% and
misoprostol 0.002%
was compounded and
applied in a layered
manner. Telfa® pads
were used to cover
the wound, and a
T-shirt was put on
to protect the
bandages. The dog
started eating
canned food that
night and in several
days she was eating
four large cans of
food daily. In
addition to the
Poly-Ox bandage, she
remained on
Cefadrops® and
Rimadyl®. She seemed
to be uncomfortable
and analgesics did
not appear to
control her pain.
The powder was
returned to the
pharmacy and
lidocaine 2% was
added. Although this
helped somewhat, the
dog was becoming
non-compliant at the
time of her dressing
changes. The
compound was again
modified to contain
bupivacaine 0.2% to
obtain an extended
analgesic effect.
This was a
significant
improvement and
therapy continued
for several months.
As healing occurred,
the dog began to
experience itching
in the regranulated
skin and wound
areas.
Diphenhydramine was
given orally along
with the Rimadyl®
and we began rubbing
her stretched skin
with Emu oil to keep
it moist. Shortly
thereafter, the dog
“became a schnauzer
again.” Her activity
level has increased
greatly and we
anticipate a
complete recovery.

When I began
treating this dog, I
thought that skin
grafting would be
necessary. Due to
the success of this
therapy, no grafting
will be needed.
However, I don’t
expect hair regrowth
and the epithelium
will remain scarred
and easily bruised.

HORSES
:

Electrolyte
Paste to Restore
Fluid and Acid Base
Balance in Horses"Prolonged
exercise in horses,
particularly when
performed in hot and
humid conditions,
brings about large
fluid and
electrolyte loses
which, if not
restored, may impair
thermoregulatory
responses and result
in hyperthermia." In
horses,
administration of
oral rehydration
solutions (ORS) is
problematic, because
many horses refuse
to drink fluids
containing
electrolytes.
Therefore,
administration of
ORS typically
requires placement
of a nasogastric
tube with its
inherent risks. An
alternative is to
give a concentrated
electrolyte mixture
as a paste. Leon et
al. of Department of
Veterinary Clinical
Sciences, University
of Sydney, NSW,
Australia studied
six Thoroughbred
geldings to
determine "whether
oral administration
of a concentrated
electrolyte paste
would promote the
restoration of
fluid, electrolyte,
and acid base
balance as well as
fluid and
electrolyte deficits
induced by
furosemide
administration" (a
standard model which
induces significant
contraction of
plasma volume and
consistent
electrolyte deficit
against which the
effects of treatment
could be measured).

"As a general
conclusion, horses
that received
concentrated
electrolytes [and
had free access] to
water consumed more
water, regained more
weight, lost
considerably less
electrolytes in
urine, and
maintained plasma
electrolyte
concentrations and
acid base balance
closer to baseline
values than did
those that had ad
libitum access to
water only."
Administration of
electrolyte paste
provided a more
practical source
than supplementation
using feed or salt
blocks.

Am J Vet Res
1998
Jul;59(7):898-903

In order to access the
PubMed abstract of this
article, visit thiswebsite link.
Progesterone for
Estrus Induction in
MaresAccording
to Robert R. Foss,
DVM, progesterone in
sesame oil, 150 mg
per day, IM is
equally as
efficacious as
altrenogest. The
optimal formulation
is the combination
of progesterone and
estradiol 17-beta;
the addition of
estradiol provides a
greater feedback
than progesterone
alone, so cessation
produces a more
dramatic response.
The estradiol is
somewhat protective
against exacerbation
of endometritis. Dr.
Foss commonly uses
this combination at
150 mg progesterone
and 10 mg estradiol
17-beta, IM, daily
for 10 days. Estrus
will usually begin
in 6-8 days with
ovulation around day
10-12. This
combination has been
effective in
situations where
altrenogest has
failed.

114th IL VMA
Proceedings,
February, 1996

Prednisone
(Oral) Ineffective
in HorsesJackson et
al. compared the
effects of
prednisone with
environmental
management to
environmental
management alone for
the treatment of
heaves (recurrent
airway obstruction),
and reported that
oral prednisone has
no additional
benefit.1

To be effective,
oral prednisone must
be absorbed and
metabolized to its
active form
prednisolone.
Robinson et al.
designed a study
with two objectives:
1) to compare oral
prednisone with
intravenous
dexamethasone for
the treatment of
horses with heaves;
and 2) to measure
serum prednisolone
levels in horses
after oral
administration of
prednisone and
prednisolone. Each
of five horses
received five drug
formulations
(prednisone and
prednisolone in
tablet and liquid
form, as well as
intravenous
prednisolone sodium
succinate as a
positive control,
all at a dose of 2.2
mg/kg) in a Latin
square design study.
Severity of airway
obstruction was
measured, and there
were no significant
differences between
prednisone
administration and
no medication at any
time. Prednisolone
was detectable in
serum immediately
after intravenous
administration,
peaking at around
1000 ng/ml at 12
min. Oral
administration of
prednisolone tablets
or liquid yielded
peak serum
prednisolone
concentrations of
377-1032 ng/ml at
30-45 min. When
horses received oral
prednisone tablets
or liquid,
prednisolone never
reached detectable
levels in the serum.
The authors
concluded, "In order
for the drug
prednisone to be
effective after oral
administration it
must be absorbed
from the
gastrointestinal
tract and converted
to the active drug
prednisolone by the
liver. Although
trace serum levels
of prednisone were
detected,
prednisolone never
appeared in the
serum. Our data do
not allow us to
determine if
prednisone is poorly
absorbed, rapidly
excreted, or not
converted to
prednisolone by the
liver. However, it
is clear that
prednisone is
unlikely to have any
anti-inflammatory
effect when
administered by
mouth. Oral
administration of
prednisolone is
likely to be
beneficial because
it is rapidly
absorbed and
achieves serum
levels close to
those that result
from intravenous
administration."2

Robert N. Oglesby,
DVM (The
Horseman's Advisor,
www.horseadvice.com)
reports his reaction
to hearing the above
presentation at the
November, 2000
meeting of the
American Association
of Equine
Practitioners: "I
was shocked and
looking around me
hundreds of other
vets were also: oral
prednisone doses are
in every equine
medicine text with
many descriptions of
its indications. Why
has no one noticed
the lack of effect
before now? The
reason is simple: no
one believed it was
possible that
[prednisone] was not
effective [in
horses]. Its
usefulness in other
species was too well
established... we
did not even
question its use.
Looking back on it,
it was the
management changes
that were
responsible for the
clinical
improvement..."

In order to access the
PubMed abstract of this
article, visit thiswebsite link.We can
compound
prednisolone into
the most appropriate
dosage form,
including oral
pastes or "chewies"
that horses will
love!

Pentoxifylline
In horses, a dose of
8.5 mg/kg orally two
times daily is
recommended for
reducing the
cytokine effects in
endotoxemia. For the
treatment of
navicular disease, 6
g/day orally for 6
weeks should be
used.

Compendium
23(7), July 2001,
603-4

Anti-Diarrheals for
Foals & HorsesTreatment
of diarrhea should
always be based on
establishing a
diagnosis and
correcting the basic
cause.
Anti-diarrheal
products are not a
substitute for
adequate fluid and
electrolyte therapy
when dehydration or
shock threatens.
When the
veterinarian deems
anti-diarrheal
therapy is
appropriate, the
following options
may be considered.

According to James
L. Becht, D.V.M.,
M.S., Diplomat
ACVIM, preparations
containing bismuth
subsalicylate seem
superior to those
containing kaolin,
pectin, or activated
charcoal for
treating the foal
with diarrhea.
Bismuth
subsalicylate
neutralizes
bacterial toxins,
has some
antibacterial
activity, and may
exert an
antisecretory
effect. It can be
administered at a
dosage of 4 oz q 6h;
darkened feces will
result. If no effect
is seen within 48
hours, continued
administration is
probably not
indicated. (105th
Ohio VMA).

Headshaking
in Horsesmay include
additional signs
such as nose
rubbing, striking at
the nose with the
forelegs, or active
avoidance of light,
warmth, or wind on
the face. Newton et
al studied 20 mature
horses with typical
headshaking of 2
week to 7 year
duration, and
concluded that the
etiopathology may be
a trigeminal
neuritis or
neuralgia. In 12 of
20 horses, drug
therapy was
initiated.
Cyproheptadine (CP)
alone was
ineffective but the
addition of
carbamazepine (CM)
resulted in 80-100%
improvement in 80%
of cases within 3 to
4 days of beginning
drug therapy. Seven
cases were treated
with a combination
of CM (4 mg/kg,
three to four times
daily) and CP
(0.2-0.5 mg/kg
every 12 to 24
hours).

Carbamazepine alone
has been effective
in 88% of cases.
Some headshaking
horses have
responded well to CM
doses of 1.6 - 2.4
grams every six
hours without
apparent side
effects. Horses are
treated for 10 to 20
days and if they
respond, the
treatment is
discontinued. If
clinical signs of
headshaking recur,
treatment is
restarted. In
practice, there is a
realistic
possibility of
controlling but not
curing headshaking
with carbamazepine
therapy at the
present time. Other
studies have
reported that
cyproheptadine alone
was beneficial in
more than two thirds
of treated horses.

Equine Vet J
2000
May;32(3):208-16

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Equine Vet J
1998
Nov;(27):28-9

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Am Vet Med
Assoc
2001 Aug
1;219(3):334-7

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Antifungal
Therapy for Avian
SpeciesIn avian
species, the most
frequent causes of
infection have
shifted from
gram-negative
bacteria to
gram-positive
bacteria and
Candida (often
non-albican)
species. There is a
decreased
susceptibility of
many non-albicans
species to available
antifungal drugs,
perhaps as a
consequence of
nondiscriminate
azole use.

The efficacy of
terbinafine has been
improved when
administered in
combination with
azoles for treatment
of azole resistant
oral candidiasis and
aspergillosis.
Because terbinafine
was administered
successfully in an
African gray parrot
at 15 mg/kg every 12
hours for 30 days
without adverse
effects, it may have
potential for use in
systemic
aspergillosis in
these
azole-sensitive
species. Caution
should be used in
avian patients with
liver or renal
disease.

Veterinary Clin
North Am Exot Anim
Pract. 2003
May;6(2):337-50, vi

Treatment of
a Systemic Fungal
Infection in a
Parrot with
Itraconazole
Flavored Suspension
and Nebulized
Clotrimazole
Submitted by Michael
Briggs, Pharm.D.

A Solomon Island
Eclectus parrot,
female aged 1.5
years, presented in
a weakened state.
Examination and
culture revealed a
systemic
Aspergillus
infection. Due to
its significant cost
as well as concern
for the pet, the
owner was highly
motivated to treat
the parrot.

Treatment posed a
challenge because
the parrot only eats
brightly-colored
foods, and there was
no commercially
available
clotrimazole
solution for
nebulization for
veterinary use. The
veterinarian
contacted the local
compounding pharmacy
to discuss how
compounded
medications might
help solve this
therapeutic dilemma.
It was decided that
an oral suspension
flavored with equal
parts orange,
banana, and
strawberry could
mask the bitter
flavor of
itraconazole, and
that a customized
dosage (20mg/ml)
could be compounded
for the parrot. The
veterinarian also
prescribed
clotrimazole 1% for
nebulization.

The owner
administered 0.2ml
(4mg) of
itraconazole
suspension to the
bird each day by
mouth using an oral
syringe. Therapy
continued for three
months. Clotrimazole
1% solution was
nebulized (1ml BID
to TID) by placing a
pediatric nebulizer
mask over the
cooperative bird’s
head. After 30 days,
the bird still had a
productive cough.
Therefore, nebulizer
therapy with
clotrimazole
continued after
total resolution of
signs and symptoms
of infection, for a
total of four months
(one month after the
oral itraconazole
was finished).

The parrot fully
recovered. This case
represented the
pharmacy’s first
attempt at avian
therapy, and was
100% successful. The
same therapy was
used later for
another bird that
also fully recovered
from a systemic
Aspergillus
infection.

Enrofloxacin
in Birds
Enrofloxacin is
highly active
against most
gram-negative
bacteria. Doses of
15 mg/kg orally
twice daily have
maintained effective
drug concentrations
in most of the
psittacine species
that have been
tested. Senegal
parrots have
required TID dosing
for moderately
resistant organisms.
Keven Flammer, DVM,
Dip ABVP, reports
successful treatment
of E coli,
Klebsiella,
and Proteus
infections. He
states that oral
administration is
well tolerated, but
that IM
administration
should be avoided,
and never used for
repeated dosing, due
to irritation at the
site of injection.
The IM formulation
can be given orally
but is unpalatable,
even when mixed with
flavoring. Dr.
Flammer notes that
an oral suspension
can be compounded
and appropriately
flavored.

Haloperidol
for Feather-Plucking
and Self-Mutilation
Neuropeptides,
particularly
dopamine, are
implicated in many
self-mutilating
disorders. The 1993
Proceedings of the
Association of Avian
Veterinarians (pg.
119-120) reports the
dopamine antagonist
haloperidol is
currently being used
on cockatiels,
lovebirds, ring-neck
parakeets, African
Greys, and several
species of cockatoos
and Amazon parrots.
The indications for
use in these birds
have included severe
feather plucking,
mutilation of skin
and muscle over the
back, chest and
legs, wing web
mutilation, and
Amazon foot necrosis
syndrome. Side
effects from the use
of haloperidol have
included depression,
depressed appetite,
excitability and
anorexia. (In most
birds, side effects
disappeared after
discontinuing the
drug for several
days and then
retrying at a lower
dose.) One
study reported
normal behavior was
maintained “by
administering
haloperidol at
approximately 0.4
mg/kg body
weight/day for
approximately seven
months.”

Journal of Small
Animal Practice
1993; 34:564-566

Haloperidol
for Feather Pluckingby
Stacie Fowler,
D.V.M., Texas

Signalment:
"Echo", adult male
Eclectus Parrot

Chief Complaint:
Feather picking of
4-6 years duration

Diagnosis:
Previous
veterinarian had
done numerous tests
in 1993 to rule out
medical causes of
feather picking and
the final diagnosis
was psychological
behavioral feather
picking.

Feather Picking:
This is a common
syndrome in pet
"parrot-type" birds
that can have
medical and/or
psychological
causes. It is
important to rule
out all medical
causes of this
condition before
initiating
psychotropic drug
therapy. It is also
important to
institute
appropriate dietary
and environmental
changes as well as
behavioral therapy
along with
psychotropic drug
use.

Past History and
Medications:
Echo first started
picking at his
feathers in 1991.
By November of 1994
he had pulled out
all his feathers
except those which
he could not reach
on his head. In
December of 1994,
Echo's previous
veterinarian started
him on naltrexone
(dose unknown) for
behavioral feather
picking. He failed
to respond to this
drug and was placed
in an Elizabethan
collar on 4/20/95 to
prevent further
plucking. The
author first saw
this patient on
1/10/97. He had been
wearing the collar
almost constantly
since 4/95 and all
his feathers were in
place (but ragged
and unkempt looking)
except under the
collar. Anytime the
collar was removed
the patient would
rip his feathers
out. The
owners wished to try
Prozac® for Echo's
problem but since
this author has had
little success with
Prozac®, we started
trials on other
drugs. Along with
changes in diet and
environment and
behavioral
exercises, we
started Echo on
Aventyl® elixir at
1/4 teaspoon per 4
ounces of drinking
water to be replaced
with fresh twice
daily. We also
initiated every
other daily misting
of the feathers with
a dilute Aloe and
Penetran®
suspension. By
3/8/97, Echo was
still plucking too
many feathers when
the collar was
removed. To
his Aventyl®
therapy, we added
naltrexone
compounded to 5
mg/ml in a
strawberry flavored
base, 0.16 ml by
mouth twice daily.
By 3/20/97 he was
still plucking badly
when the collar was
removed.

The Aventyl® and
naltrexone were
discontinued and we
did a brief trial on
diazepam 2 mg per 4
ounces of drinking
water. The diazepam
is not meant to
sedate and the owner
was instructed to
increase the dose to
a maximum of 10 mg
per 4 ounces of
water if feather
plucking continued
but only if no
sedation was noted.
The diazepam
produced no change
in behavior and
caused too much
sedation for Echo.
On 4/10/97 we began
a trial on
haloperidol 2 mg/ml
at .015 ml by mouth
once daily. The
owners were
instructed that they
could increase the
dose to maximum of
.06cc of 2 mg/ml
haloperidol twice
daily. By 5/7/97,
Echo's owners
reported that they
were giving .075 cc
of 2 mg/ml
haloperidol twice
daily and he seemed
to be responding
nicely. On 5/17/97
the haloperidol was
refilled and
compounded to 1
mg/ml to facilitate
easier measuring.
As of 9/2/98, Echo
is receiving
haloperidol 0.15 mg
by mouth twice
daily. This is a
higher dose than I
have seen published
in the literature
but the owners are
pleased with Echo's
condition and do not
wish to try a lower
dose or even
possibly wean him
off the haloperidol.
Echo is not
experiencing any
noticeable side
effects from his
haloperidol therapy.
Currently, Echo
never wears his
Elizabethan collar
and is totally
feathered in except
for his neck. I
believe that 2 years
of constant pressure
from the collar has
caused atrophy of
the feather
follicles around the
neck.

We
welcome your
questions and the
opportunity to help
you solve medication
problems.

MISCELLANEOUS
:

Efficacy of
oral supplementation
with L-lysine in
cats latently
infected with feline
herpesvirus

Maggs et al. of the
College of
Veterinary Medicine,
University of
Missouri examined
the effects of
orally administered
L-lysine on clinical
signs of feline
herpesvirus type 1
(FHV-1) infection
and ocular shedding
of FHV-1 in latently
infected cats. Fewer
cats and eyes were
affected by
conjunctivitis, and
onset of clinical
signs of infection
was delayed on
average by 7 days in
cats receiving
L-lysine 400 mg once
daily for 30 days,
compared with cats
in the control
group. Significantly
fewer viral shedding
episodes were
identified in the
treatment group
cats, compared with
the control group
cats. This dose
caused a significant
but short-term
increase in plasma
L-lysine
concentration
without altering
plasma arginine
concentration or
inducing adverse
clinical effects.

Am J Vet Res
2003 Jan;64(1):37-42

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

DextromethorphanOf the
seven major human
cough suppressants,
only
dextromethorphanis
indicated for
treating cough in
small animals. If
after reviewing the
indications and
contraindications,
cough suppression is
desired, the
available human
products must be
screened carefully
as a very limited
number contain
dextromethorphan
without other
potentially harmful
ingredients.
Typically, the dose
in dogs and cats is
1 to 2 mg/kg three
to four times daily.
Human products are
not flavored to an
animal’s taste, and
may require
administering a
significant volume
(typical strength is
15 mg/5 ml) to
adequately dose an
average size dog.

Stool
SoftenersDocusate
(DSS) can be used to
assist in the
passage of hard or
dry feces that may
occur secondary to
dehydration or use
of opioid analgesics
or metoclopramide.
While capsules hide
the bitter taste,
they can not be
divided for
appropriate dosing
in smaller animals.
The recommended dose
in dogs and cats is
2 mg/kg once daily.
For more severe
cases, appropriately
dosed DSS enemas may
offer an alternative
to
phosphate-solution
enemas.

Merck Veterinary
Manual, 8th
Edition, pp. 1691

Ursodiol for
GallstonesThe purpose
of this study,
reported in Am J
Health-Syst Pharm
(Vol. 52) was
to prepare an oral
dosage form of the
bile acid ursodiol
(also known as
ursodeoxycholic
acid) from
commercially
available capsules
and to determine the
short-term stability
of this formulation.
The formula used for
this extemporaneous
compound was found
to be stable for up
to 35 days.

Ursodiol in
a Dog with Chronic
HepatitisA dog with
severe cholestasis
secondary to chronic
hepatitis was
treated with
ursodeoxycholic acid
(ursodiol) orally.
After 2 weeks of
daily treatment, the
dog was more active
and had an improved
appetite. Monthly
serum biochemical
determinations and
analysis of
individual bile acid
profiles documented
improvement in
hepatobiliary tests
and a marked
reduction in the
concentrations of
potentially
hepatotoxic
endogenous bile
acids. These effects
were maintained for
approximately 6
months.

J Vet Intern Med
1997
May-Jun;11(3):195-7

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Studies have found
an extemporaneously
compounded ursodiol
suspension to be
stable for up to 35
days refrigerated.
This drug is well
absorbed orally and
enters the liver
directly from the
portal system, and
is then secreted
into bile. Ursodiol
should be
administered orally
as the first-pass
effect is vital for
effectiveness.

Aminocaproic
Acid for
Degenerative
Myelopathy (DM) in
DogsDM appears
with relative
frequency only in
the German Shepherd
breed (GSD);
confirmation of the
diagnosis is
important in other
breeds before
assuming that they
have DM of GSD.
During the past two
decades, R.M.
Clemmons, DVM,
Ph.D., and other
researchers at the
University of
Florida have
provided important
new insights into
the pathoetiology of
DM. Recently, they
have found that when
combined with the
history, neurologic
signs, CSF protein
concentration and
EMG, an elevated CSF
acetylcholinesterase
level helps confirm
the diagnosis. It is
increasingly clear
that DM is caused by
an autoimmune
disease attacking
the nervous systems
of patients, leading
to progressive
neural tissue
damage. In many
respects, DM is
similar to Multiple
Sclerosis in human
beings.

The Integrative
Medical Approach to
Treatment of
Degenerative
Myelopathy involves
four basic
approaches: 1)
exercise, 2) dietary
supplementation, 3)
medication, 4) other
supportive measures.
Conventional
medicine has little
to offer patients
with DM. On the
other hand, use of
exercise, certain
vitamins and
selected drugs have
delayed or prevented
progression of DM in
many afflicted dogs.

Clemmons et al have
found 2 medications
which appear to
prevent progression
or result in
clinical remission
of DM in up to 80%
of patients -
aminocaproic acid
(EACA) and
n-acetylcysteine
(NAC). They propose
that circulating
immune-complexes
lead to endothelial
cell damage in the
vessels of the CNS.
Subsequently, fibrin
is deposited in the
perivascular spaces.
When this degrades
(point of action of
aminocaproic acid),
inflammatory cells
are stimulated to
migrate into the
lesions. The
inflammatory cells
release
prostaglandins and
cytokines (point of
action of vitamin E
and C) which lead to
the activation of
tissue enzymes and
the formation of
oxygen free-radicals
(point of action of
acetylcysteine)
which, in turn,
leads to tissue
damage.They
recommend giving
EACA as a flavored
solution, 500 mg
orally every 8
hours. A “source for
EACA is to have a
compounding pharmacy
make the solution
from chemical grade
EACA.” The
only side effects
that have been
attributed to EACA
have been occasional
gastrointestinal
irritation. This has
presented a problem
only in a few
patients, typically
those with
pre-existing GI
problems. The only
known drug
interaction is with
high dose estrogen
compounds.

N-Acetylcysteine is
a potent
anti-oxidant which
has powerful
neuroprotective
effects. Clemmons et
al give 75 mg/kg
divided in 3 doses a
day for 2 weeks;
then, 3 doses every
other day. The
N-acetylcysteine
must be diluted to a
5% solution;
otherwise, it will
cause stomach upset.
“This new treatment
is expensive unless
purchased through
compounding
pharmacies.” NAC can
produce vomiting
(due to the sodium
content of the
pharmaceutical
product, which
requires high
concentration of
base to buffer) and
may increase the
bleeding time.
Giving fresh ginger
30 minutes before
NAC or administering
NAC with food (or on
a full stomach)
often reduces this
effect.

The chances of
successful treatment
are improved if the
therapy is begun
early in the course
of DM rather than
later. A response to
the drugs should be
evident within the
first 7-10 days.

Chlorpromazine for
Anti-Emesis
Chlorpromazine
(Thorazine®) is a
phenothiazine and
works at the emetic
center, the
chemoreceptor
trigger zone, and
peripheral
receptors; it is
this veterinarian’s
“all purpose
anti-emetic of
choice” for cats.1
Chlorpromazine may
cause extrapyramidal
symptoms in cats
when administered at
high doses. The drug
may discolor urine
pink or red-brown,
cause mild sedation,
and may potentiate
hypotension in
dehydrated patients.
Phenothiazines
should not be given
within one month of
worming with an
organophosphate
agent. The
recommended oral
doses in dogs and
cats is 3.3 mg/kg PO
one to four times
daily. Due to
extensive first pass
metabolism2,
it may be necessary
to reduce the dose
in animals with
liver disease. A
liquid concentrate
can be appropriately
flavored for dogs or
cats.

Managing
Anorexia in Uremic
Dogs and CatsH2-receptor
antagonists
(cimetidine,
ranitidine, and
famotidine) can be
useful to reduce
gastric acid
secretion. Increased
gastrin
concentrations in
serum during chronic
renal failure may
stimulate excessive
secretion of gastric
acid and cause ulcer
formation. Some
uremic dogs and cats
dramatically
increase their
interest in food and
food intake after
therapy with an H2
blocker. According
to a presentation at
the Atlantic Coast
Veterinary
Conference by Dennis
J. Chew, DVM, Dip
and C.A. Buffington,
DVM, some uremic
animals may need
this medication for
an extended period
of time (months to
rest of their
lives). Much of the
experience of these
veterinarians has
been either with
cimetidine at an
initial dose of 10
mg/kg, followed by 5
mg/kg PO BID or
famotidine at 1
mg/kg daily.

The Capsule
Report, Vol.
19, No. 10, Jan.
2001

Doxycycline
for Prophylaxis and
Treatment of
Osteoarthritis in
Dogs
Prophylactic
administration of
doxycycline (a
tetracycline) has
markedly reduced the
severity of canine
osteoarthritis (OA)
in weight-bearing
regions of the
medial femoral
condyle, and
therapeutic
administration of
oral doxycycline has
been shown to reduce
the severity of
articular cartilage
breakdown in various
animal models of OA.
This disease
modifying effect is
associated with
reductions in the
levels of active and
total collagenase
and gelatinase in
articular cartilage
of the involved
joint.

A prospective,
clinical study of
eighty-one dogs with
OA secondary to
spontaneous cranial
cruciate ligament
(CCL) rupture
concluded that
doxycycline inhibits
nitric oxide
production in
cartilage in dogs
with CCL rupture,
and that doxycycline
may have a role in
the treatment of
canine OA. Dogs with
OA secondary to CCL
rupture were divided
into 2 groups before
surgery. The
Doxy-CCL group (n =
35) received 3 to 4
mg/kg doxycycline
orally every 24
hours for 7 to 10
days. The CCL group
(n = 46) received no
treatment. Synovial
fluid, articular
cartilage, synovial
membrane, and CCL
samples were
collected during
surgery or
immediately after
euthanasia from
healthy dogs
(control group).
Total nitric oxide
concentrations
measured in
cartilage were
significantly lower
in the Doxy-CCL
group than in the
CCL group, but were
not different from
those measured in
the control group.

In another study,
ten healthy adult
mongrel dogs
underwent
transection of the
left anterior
cruciate ligament,
which resulted in a
marked decrease in
bone mass, with
increased
osteoclastic
activity and
increased bone
formation.
Doxycycline
treatment did not
significantly affect
either bone
formation or bone
resorption. The
authors concluded
that doxycycline
protects against
joint breakdown in
this OA model via
inhibition of matrix
metalloproteinases
in articular
cartilage, rather
than through an
effect on
subchondral bone.

Vet Surg
2001
Mar-Apr;30(2):132-9

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Rheumatol
1996
Jan;23(1):137-42

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

J Rheumatol
Suppl 1995
Feb;43:149-51

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Vet Clin North
Am Small Anim Pract
1997
Jul;27(4):863-81

Arthritis Rheum
1992
Oct;35(10):1150-9

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

Cisapride: a
Prokinetic Drug

Cisapride
(Propulsid® -
Janssen
Pharmaceutica), was
removed from the
U.S. and Canadian
markets by its
manufacturer because
of serious cardiac
effects in humans.
However, cisapride is now
available as a bulk
chemical for
veterinary use only
and can be
compounded as per
your prescription
order.

Cisapride is
chemically related
to metoclopramide,
but unlike
metoclopramide, it
does not cross the
blood-brain barrier
or have
antidopaminergic
effects or cause
extrapyramidal
reactions. Cisapride
“is more potent and
has broader
prokinetic activity
than metoclopramide,
increasing the
motility of the
colon, esophagus (in
cats and guinea
pigs), stomach, and
small intestine...
[Cisapride] has been
used in managing
gastric stasis,
idiopathic
constipation,
gastroesophageal
reflux, and
postoperative ileus
in dogs and cats.
Practitioners found
cisapride especially
useful in managing
chronic constipation
in cats with
megacolon; in many
cases, it alleviated
or delayed the need
for subtotal
colectomy. Cisapride
was also used in
managing cats with
hairball problems.”

“Cisapride appeared
to be well tolerated
by dogs and cats.
Adverse reactions to
cisapride have not
been reported to the
United States
Pharmacopeia’s
Veterinary
Practitioners’
Reporting Program...
Disorders of GI
motility are common
and frustrating
clinical problems in
dogs and cats.
Cisapride, with its
extensive prokinetic
action, was a
welcome addition to
veterinary
medicine.”

Doses:Dogs -
As a promotility
agent: initially
0.5mg/kg three times
daily
To reduce
regurgitation
associated with
megaesophagus:
0.55mg/kg orally
one to three times
daily, no less than
30 minutes before
feeding.
As an antiemetic:
0.1-0.5mg/kg orally
every 8 hours.

Cats -
For chronic
constipation:
initially, 2.5mg
(for cats up to 10#)
or 5mg
(cats 11-15#), or up
to 7.5mg (for cats
over 16#) three
times daily, 30
minutes before food,
in combination with
stool softener and
bulk agent.

Cisapride is
contraindicated in
patients in whom
increased GI
motility could be
harmful (e.g.,
perforation,
obstruction, GI
hemorrhage).
Absorption of other
orally-administered
drugs may be
affected. Cisapride
may enhance
anticoagulants’
effects; additional
monitoring and
anticoagulant dosage
adjustments may be
required. Cisapride
may enhance the
sedative effects of
benzodiazepines.
Clients should be
advised to monitor
the animal and
report any adverse
effects.

Hairball
RemedyCat and
ferret owners
continually search
for specialized
foods and treats
that their pets will
readily consume and
will also be
effective for
hairball prevention
or elimination.
Call us
for a customized,
flavored hairball
remedy for your
patients!

StanozololIn a study
conducted at the
Animal Health Unit
and Gastrointestinal
Sciences, University
of Calgary, Alberta,
ten healthy, intact,
adult male sled dogs
received either
stanozolol tablets,
2 mg/dog PO, q12h,
for 25 days or an
intramuscular
injection of
stanozolol 25 mg on
Days 7, 14, 21, and
28. A 15N amino acid
(5.27 mmol) was
infused
intravenously into
each dog on Day 0
(before stanozolol
treatment) and on
Day 31 (after
stanozolol
treatment). Both
oral and injectable
stanozolol resulted
in significant
increases in amino
acid nitrogen
retention compared
to pretreatment
values. Oral
stanozolol increased
nitrogen retention
from 29.2 +/-8.2% to
50.3 +/- 9.2%, while
stanozolol injection
increased nitrogen
retention from 26.6
+/- 9.9% to 67.0 +/-
7.5%. The nitrogen
retention action of
stanozolol may be
beneficial in dogs
under stress of
surgical trauma and
chronic disease.

In a separate
blinded crossover
trial at the College
of Veterinary
Medicine, Kansas
State University, 22
castrated Beagles
with experimentally
induced chronic
renal failure were
treated with
stanozolol. Cowan
et al.
concluded that for
dogs with
mild-to-moderate,
nonuremic,
experimentally
induced, chronic
renal failure,
stanozolol had
positive effects on
nitrogen balance and
lean body mass.
Stanozolol did not
have a significant
effect on body fat,
bone mineral
content, or food
consumption per
kilogram of body
weight.

Anabolic steroids
such as stanozolol
have been used to
treat geriatric
dogs. These drugs
can increase
nitrogen and mineral
retention so that
the body can better
utilize dietary
protein. As a
result, the dog’s
appetite may
improve, resulting
in more strength,
energy, and weight
gain. There is one
reported case of the
use of stanozolol
(0.5 mg/kg, SQ, BID,
PRN) to stimulate
appetite in a
rabbit. However,
this class of drugs
is not without
potentially serious
side-effects which
must be considered
before using them.
Anabolic steroids
should be used with
caution in animals
with heart, liver,
or kidney problems,
or in animals with
breast or prostate
cancer. Stanozolol
should not be used
in pregnant animals,
during lactation, in
young animals, or in
male breeding
animals. Anabolic
steroids may
increase the effects
of warfarin and
other
anticoagulants.

In dogs, reported
side effects are
mainly androgenic,
including increased
aggression,
increased activity,
weight gain and mood
alterations.
However, in cats
with and without
chronic renal
failure, there are
reported cases of
hepatotoxicity that
appear to be related
to the use of
stanozolol.

J Am Vet Med
Assoc. 1997 Sep
15;211(6):719-22

In order to access the
PubMed abstract of this
article, visit thiswebsite link.Can J Vet Res.
2000 Oct;64(4):246-8

In order to access the
PubMed abstract of this
article, visit thiswebsite link.Veterinary Forum.
April 1999

In order to access the
PubMed abstract of this
article, visit thiswebsite link.

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